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Drop-off in positivity rate of stress echocardiography based on regional wall motion abnormalities over the last three decades

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Abstract

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.

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Abbreviations

CAD:

Coronary artery disease

CFVR:

Coronary flow velocity reserve

LVCR:

Left ventricular contractile reserve

RWMA:

Regional wall motion abnormalities

SE:

Stress echocardiography

TTE:

Transthoracic echocardiography

WMSI:

Wall motion score index

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Funding

This study was supported by Institutional funds of Institute of Clinical Physiology of National Research Council of Pisa.

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Authors and Affiliations

  1. Cardiology Division, San Luca Hospital, Lucca, Italy

    Lauro Cortigiani & Francesco Bovenzi

  2. National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico

    Pamela Ramirez

  3. Department of Computer Science and Technology, ESTAR, Toscana, Pisa, Italy

    Maico Coltelli

  4. Institute of Clinical Physiology, Biomedicine Department, CNR, CNR Research Campus, Via Moruzzi, 1, 56124, Pisa, Italy

    Eugenio Picano

Authors
  1. Lauro Cortigiani
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  2. Pamela Ramirez
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  3. Maico Coltelli
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  4. Francesco Bovenzi
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  5. Eugenio Picano
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Correspondence to Eugenio Picano.

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The authors declare that they have no conflict of interests.

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Cortigiani, L., Ramirez, P., Coltelli, M. et al. Drop-off in positivity rate of stress echocardiography based on regional wall motion abnormalities over the last three decades. Int J Cardiovasc Imaging 35, 627–632 (2019). https://doi.org/10.1007/s10554-018-1501-3

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  • DOI: https://doi.org/10.1007/s10554-018-1501-3

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