# Arterial Stiffness is Associated with False-Positive ST-Segment Depression in Supine Bicycle Exercise Stress Echocardiography

## TL;DR

This study finds that arterial stiffness is linked to false-positive ST-depression during stress echocardiography, which can lead to misdiagnosis of heart disease.

## Contribution

The study identifies arterial stiffness and hemodynamic factors as independent predictors of false-positive ST-depression in stress echocardiography.

## Key findings

- Higher brachial-ankle pulse wave velocity (baPWV) is independently associated with false-positive ST-depression.
- Increased pulmonary arterial systolic pressure (PASP) and peak heart rate are also independently linked to false-positive ST-depression.
- Arterial stiffness and diastolic dysfunction may cause subclinical ischemia, leading to false-positive results.

## Abstract

Although exercise stress electrocardiography (ECG) is a
popular tool for detecting coronary artery disease (CAD), the induced
ST-depression without coronary artery stenosis (FST) remains a challenge for
accurate diagnosis. Exercise-induced ST depression is related to poor prognosis
even in non-obstructive disease; however, its determinants have not been fully
defined. We sought to investigate whether ventriculo-vascular interactional
indexes such as arterial stiffness index, exercise hemodynamic parameters and
echocardiographic left ventricular (LV) functional parameters were related to
FST.

In the current study, 609 participants who underwent both
supine bicycle exercise echocardiography and brachial-ankle pulse wave velocity
(baPWV) measurement without exercise-induced regional wall motion abnormalities
(RWMA) were analyzed. Referral reasons for stress test were CAD detection or
evaluation of patency of previous revascularization. Stepwise graded supine
bicycle exercise was performed with simultaneous ECG recording and
echocardiography after full conventional resting echocardiography. The FST was
defined as newly developed >1 mm ST depression without RWMA during exercise.

The median age of the study participants was 65 (59.0–70.5)
years, and 222 (37%) patients were women. Among them, 103 (17%) patients showed
FST during the exercise or recovery phase. The prevalence of FST did not differ
between sexes. Older age, higher pulmonary arterial systolic pressure (PASP),
left atrial volume index, baPWV and ankle brachial index at rest and hypertensive
response, higher heart rate and rate-pressure product at peak exercise were
significantly associated with FST. In multivariate analysis, higher peak heart
rate, PASP, and baPWV were independently related to FST.

Stress-induced RWMA in addition to ECG should be evaluated to detect CAD in
patients with higher baPWV and PASP. FST might be linked to subclinical
myocardial ischemia through arterial stiffness and diastolic dysfunction.