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Predictors and Prognostic Significance of False-Positive Results in Dobutamine Stress Echocardiography
Session:
Sessão de Posters 22 - Imagem em hemodinâmica complexa e doença valvular
Speaker:
Mariana S Silva
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters Eletrónicos
FP Number:
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Authors:
Mariana S Silva; Tiago Filipe Aguiar; Inês Amorim Cruz; Carlos Oliveira Costa; Simão Almeida Carvalho; Ana Faustino; Mesquita Bastos
Abstract
<p>Introduction: Although dobutamine stress echocardiography (SE) has high specificity, a subset of patients presents false-positive (FP) results, and their clinical profile and prognostic impact remain uncertain. </p> <p>Objective: To identify clinical and echocardiographic predictors of FP results on SE and to evaluate their prognostic implications. </p> <p>Methods: Retrospective study of 355 consecutive patients undergoing SE for ischemia assessment over a one-year period. A FP result was defined as a positive SE for ischemia in the absence of ≥50% coronary artery (CA) lesion in a major artery of the corresponding coronary territory on angiography. Patients were classified as FP+ or FP0 regarding the presence (FP+) or the absence of FP result on SE. Demographics, risk factors, clinical, laboratory and echocardiographic variables were analyzed. Variables with p<0.10 in univariate analysis were considered for multivariable logistic regression. Median follow-up was 8 years (FP+: 7.5 [1–9] vs FP0: 8 [1–9]). </p> <p>Results: FP results occurred in 4.5% (n=16). Compared with FP0, FP+ patients had higher mean arterial pressure (MAP) at rest (99.3 ± 16.25 vs 75.8 ± 17.0 mmHg; p=0.001) and at peak stress (145 [113–150] vs 101.5 [63–161] mmHg; p=0.009), and more frequently exhibited a hypertensive response (37.5% vs 8.0%; p<0.001). No significant differences were observed in age, sex, comorbidities, baseline ventricular function, CA disease, medication or complete left bundle branch block.In multivariable analysis, peak MAP was the strongest independent predictor of FP (OR 1.07; 95% CI 1.01–1.14; p=0.031). A separate model including basal MAP also demonstrated a significant association, with basal MAP independently predicting FP (OR 1.05; 95% CI 1.01–1.09; p=0.044). </p> <p>During follow-up, there were no significant differences between FP+ and FP0 in heart failure hospitalizations (18.8% vs 25%; p=0.742), myocardial infarction (12.5% vs 12%; p=1.000) or all-cause mortality (12.5% vs 20%; p=0.715). Kaplan–Meier curves showed no difference in cumulative MI risk (log-rank p=0.893). </p> <p>Conclusion: FP results on SE are associated with a more pronounced hypertensive response and higher MAP during stress. However, FP results were not associated with increased long-term risk of myocardial infarction, heart failure or mortality, suggesting that FP primarily reflects a hemodynamic phenotype without adverse prognostic impact.</p>
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