Drop-off in positivity rate of stress echocardiography based on regional wall motion abnormalities over the last three decades.
Lauro CortigianiPamela RamirezMaico ColtelliFrancesco BovenziEugenio PicanoPublished in: The international journal of cardiovascular imaging (2018)
Previous studies have suggested a decline in positivity of stress cardiac imaging based on regional wall motion abnormalities (RWMA). To assess the rate of RWMA positivity of stress echocardiography (SE) over 3 decades in the same primary care SE lab. We retrospectively assessed the rate of SE positivity in 7626 SE tests (dipyridamole in 5053, dobutamine in 2496, exercise in 77) in consecutive patients with known or suspected coronary artery disease and /or heart failure who performed SE in a primary care referral center from April 1991 to May 2018. Starting April 2005, SE based on RWMA was complemented by assessment of coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery. Starting October 2016, we added left ventricular contractile reserve (LVCR). Starting October 2016, we also added B-lines by lung ultrasound. There was a progressive decline over time in the rate of SE positivity based on RWMA from 24% (1991-1999) to 10% (2000-2009) down to 4% (2010-2018) (p < 0.0001). Positivity rate was 29% with CFVR, 16% with LVCR, and 12% with B-lines. Over three decades, we observed a dramatic decline in SE positivity rate based on classical RWMA. In the last decade, the positivity rate rose sharply thanks to the stepwise introduction of CFVR, LVCR and B-lines as additional positivity criteria in integrated quadruple SE.
Keyphrases
- left ventricular
- primary care
- heart failure
- coronary artery
- coronary artery disease
- magnetic resonance imaging
- computed tomography
- pulmonary hypertension
- pulmonary artery
- helicobacter pylori
- percutaneous coronary intervention
- high resolution
- acute myocardial infarction
- skeletal muscle
- cardiovascular disease
- photodynamic therapy
- high intensity
- cardiac resynchronization therapy
- mitral valve
- high speed
- helicobacter pylori infection
- general practice
- resistance training
- pulmonary arterial hypertension