Journal of Clinical Medicine
When Exercise ECG and Stress Echocardiography Disagree: Thoracic Geometry as a Potential Determinant of Exercise-Induced ST-Segment Abnormalities
By Andrea Sonaglioni, Michele Lombardo, Gian Luigi Nicolosi and 2 others.
Abstract
Background
Exercise-induced ST-segment depression may occur despite negative exercise stress echocardiography (ESE) and absence of obstructive coronary artery disease (CAD), creating diagnostic uncertainty in symptomatic patients. Whether thoracic geometry contributes to this discordant response remains poorly understood. We investigated factors associated with a positive exercise ECG despite negative ESE (ECG+/ESE−), with particular focus on antero-posterior (A-P) thoracic diameter.
Methods
In this prospective, single-center study, 101 consecutive symptomatic patients undergoing evaluation for suspected obstructive CAD were enrolled. ESE and coronary computed tomography angiography (CCTA) were prospectively planned in all patients. A positive exercise ECG was defined by horizontal/downsloping ST-segment depression ≥ 1.0 mm or upsloping depression ≥ 1.5 mm. ESE was considered negative in the absence of new or worsening regional wall-motion abnormalities. Patients with ECG+/ESE− and ECG−/ESE− responses were compared, and factors associated with ECG positivity were assessed by logistic regression. The discriminatory performance of A-P thoracic diameter was explored using ROC analysis.