Positive vasodilator stress ECG with normal myocardial perfusion imaging and its correlation with coronary angiographic findings in African Americans and Hispanics.
BACKGROUND
Ischemic electrocardiographic (ECG) changes during vasodilator stress testing (VST) in the presence of abnormal myocardial perfusion imaging (MPI) are uncommon and are associated with presence of multivessel coronary artery disease (CAD). However, there is a paucity of data regarding the significance of ischemic ECG changes during VST with normal MPI in general, and especially among African Americans and Hispanics.


OBJECTIVE
Ischemic changes during VST with normal MPI are associated with significant CAD.


METHODS
A retrospective review was done of 2945 patients undergoing VST.


RESULTS
Only 20 patients (0.7%) had positive ECG changes with normal MPI. Their demographics were: 60% Hispanic, 40% African American; 85% female; mean age 63 ± 11 years; history of hypertension 80%, diabetes 50%, and dyslipidemia 75%; smokers 30%; atypical chest pain 60%, and typical chest pain 40%. Of these 20 patients, 12 patients underwent coronary angiography. All 12 had significant CAD; nine (75%) had multivessel disease and 3 (25%) had single-vessel disease. Prevalence of clinical variables and risk factors for CAD were similar among both the groups who did and did not undergo coronary angiography.


CONCLUSIONS
Among African Americans and Hispanics, ischemic ECG changes during VST with normal MPI are likely to be associated with significant CAD and may warrant coronary angiography to assess presence and extent of CAD.
Department of Cardiology, Bronx-Lebanon Hospital Center, New York, New York.
Neelima
N
Paladugu
Department of Cardiology, Bronx-Lebanon Hospital Center, New York, New York.
Hussein
H
Shaqra
Department of Cardiology, Bronx-Lebanon Hospital Center, New York, New York.
Steve
S
Blum
Department of Cardiology, Bronx-Lebanon Hospital Center, New York, New York.
Narendra C
NC
Bhalodkar
D000241:Adenosine; D001741:Black or African American; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D004176:Dipyridamole; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents
D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine