Arterial Stiffness is Associated with False-Positive ST-Segment Depression in Supine Bicycle Exercise Stress Echocardiography

Abstract

Although exercise stress electrocardiography (ECG) is a popular tool for detecting coronary artery disease (CAD), the

induced ST-depression without coronary artery stenosis (FST) remains a challenge for accurate diagnosis. Exercise-induced ST depression

is related to poor prognosis even in non-obstructive disease; however, its determinants have not been fully defined. We sought

to investigate whether ventriculo-vascular interactional indexes such as arterial stiffness index, exercise hemodynamic parameters and

echocardiographic left ventricular (LV) functional parameters were related to FST. Methods: In the current study, 609 participants

who underwent both supine bicycle exercise echocardiography and brachial-ankle pulse wave velocity (baPWV) measurement without

exercise-induced regional wall motion abnormalities (RWMA) were analyzed. Referral reasons for stress test were CAD detection or

evaluation of patency of previous revascularization. Stepwise graded supine bicycle exercise was performed with simultaneous ECG

recording and echocardiography after full conventional resting echocardiography. The FST was defined as newly developed >1 mm

ST depression without RWMA during exercise. Results: The median age of the study participants was 65 (59.0–70.5) years, and 222

(37%) patients were women. Among them, 103 (17%) patients showed FST during the exercise or recovery phase. The prevalence of

FST did not differ between sexes. Older age, higher pulmonary arterial systolic pressure (PASP), left atrial volume index, baPWV and

ankle brachial index at rest and hypertensive response, higher heart rate and rate-pressure product at peak exercise were significantly associated

with FST. In multivariate analysis, higher peak heart rate, PASP, and baPWV were independently related to FST. Conclusions:

Stress-induced RWMA in addition to ECG should be evaluated to detect CAD in patients with higher baPWV and PASP. FST might be

linked to subclinical myocardial ischemia through arterial stiffness and diastolic dysfunction.