{"doi":"10.21037/cdt-23-296","title":"Association of abnormal electrocardiography response on dobutamine stress echocardiogram with longer-term major adverse cardiovascular events in women with symptoms of ischemic heart disease","abstract":"Background: Prior work demonstrates patients with positive (+) electrocardiogram (ECG) but negative (−) echocardiogram wall motion abnormalities (WMAs) on dobutamine stress echocardiography (DSE) testing have an elevated of major adverse cardiovascular events (MACEs). In this study, we aimed to evaluate the long-term prognosis of women with suspected ischemia with no obstructive coronary artery (INOCA) disease by utilizing core lab read DSE, specifically focusing on those with + ECG findings. Methods: Among women with signs and symptoms of myocardial ischemia undergoing clinically indicated coronary angiography enrolled in the Women’s Ischemia Syndrome Evaluation (WISE) [1997–2001], a prospective cohort study, 99 underwent standardized DSE by site design. Women with positive DSE (n=17), defined as an increase in score based on wall motion scoring index were excluded except for akinetic to dyskinetic (n=10), providing 82 patients in this analysis. ECG was assessed by core laboratory and (+) ECG was defined as >1 mm ST change. Non-obstructive coronary artery disease (CAD) was assessed by core laboratory quantitative coronary angiography and defined as <50% epicardial stenosis. All-cause death follow-up was an average of 8 years, while adjudicated MACE [all-cause mortality, nonfatal myocardial infarction (MI), nonfatal stroke, heart failure hospitalization] was an average of 5.5 years. Comparisons among subject groups [i.e., (+) ECG and (–) ECG] were made using chi-square or Fisher’s exact tests for categorical variables and t-test or Wilcoxon rank-sum test for continuous variables. Results: Demographic profile included a mean age 59±10 years; 55% had hypertension (HTN), 29% diabetes mellitus (DM), and 72% non-obstructive CAD. Overall, 9/82 women (11%) had (+) ECG in the absence of WMAs. There were significant differences in family history of CAD (P=0.009) and vasodilator (P=0.042) use between the (+) ECG and (−) ECG groups, but otherwise had no significant demographic or clinical differences. At longer-term follow up, patients with (+) ECG had higher risk of MACE [unadjusted hazard ratio (HR): 4.91, 95% confidence interval (CI): 1.83, 13.19, P=0.002]. Conclusions: Abnormal stress ECG findings on dobutamine stress testing with a negative DSE should be viewed as an indicator of longer-term risk in women with signs and symptoms of ischemia.","journal":"Cardiovascular Diagnosis and Therapy","year":2023,"id":376209,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9627,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":795978,"name":"Benita Tjoe","orcid":"0000-0001-9184-9437","position":1,"is_corresponding":false},{"id":385959,"name":"Chrisandra Shufelt","orcid":"0000-0001-6886-9210","position":2,"is_corresponding":false},{"id":385957,"name":"Janet Wei","orcid":"0000-0002-1311-618X","position":3,"is_corresponding":false},{"id":614900,"name":"Marie Lauzon","orcid":"0000-0002-6900-139X","position":4,"is_corresponding":false},{"id":1138382,"name":"Judy Luu","orcid":"0000-0002-1429-0788","position":5,"is_corresponding":false},{"id":944347,"name":"Anum Asif","orcid":"0000-0001-8241-5063","position":6,"is_corresponding":false},{"id":1139006,"name":"Jannet F. Lewis","orcid":"0009-0008-4194-4581","position":7,"is_corresponding":false},{"id":255714,"name":"Carl J. Pepine","orcid":"0000-0002-6011-681X","position":8,"is_corresponding":false},{"id":235805,"name":"Leslee J. Shaw","orcid":"0000-0003-1268-1491","position":9,"is_corresponding":false},{"id":314521,"name":"Eileen Handberg","orcid":"0000-0002-7805-9577","position":10,"is_corresponding":false},{"id":73083,"name":"C. Noel Bairey Merz","orcid":"0000-0002-9933-5155","position":11,"is_corresponding":false},{"id":1139005,"name":"Sachini Ranasinghe","orcid":"0000-0001-9431-0381","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T01:16:28.318749Z","pmid":"38162097","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}