Evidence map›Paper›PMID 30527992›Full record

ArticleInternational journal of cardiology2019

Accuracy of non-invasive stress testing in women and men with angina in the absence of obstructive coronary artery disease.

Vedant S Pargaonkar, Yuhei Kobayashi, Takumi Kimura, Ingela Schnittger, Eric K H Chow, Victor F Froelicher, Ian S Rogers, David P Lee, William F Fearon, Alan C Yeung and 2 more

Registry-linked trialOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of cardiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00823563 (Evaluation of Patients With Angina in the Absence of Obstructive Coronary Artery Disease), which is not on this map. Cited by 20 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00823563 recruitingnot on this map

Evaluation of Patients With Angina in the Absence of Obstructive Coronary Artery Disease

Typeobservational_patient_registrySponsorStanford UniversityRan2007 to 2047Enrolled2,000ConditionsChest Pain, IschemiaArms30 cc blood draw, Intravascular ultrasound (IVUS), Coronary pressure/flow wire testing, Coronary pressure/flow testing: Acetycholine challenge, Procedure: Coronary pressure/flow testing: Nitroglycerin challenge
3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.

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  17. Invasive assessment of myocardial bridging in patients with angina and no obstructive coronary artery disease.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2021
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 1 institution in 1 country.

Vedant S PargaonkarDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
Yuhei KobayashiDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
Takumi KimuraDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
Ingela SchnittgerDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
Eric K H ChowThe Quantitative Sciences Unit, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
Victor F FroelicherDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
Ian S RogersDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
David P LeeDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
William F FearonDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
Alan C YeungDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
Marcia L StefanickStanford Prevention Research Center, Stanford School of Medicine, Stanford, CA, USA.
Jennifer A TremmelDivision of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA. Electronic address: jtremmel@stanford.edu.
Stanford Medicine · US

Funding

Sex Differences: Pathophysiology of Symptomatic Non-Obstructive Coronary DiseaseK23HL092233 · NHLBI · STANFORD UNIVERSITY · PI TREMMEL, JENNIFER ANN · 2009 to 2013
$680k
NHLBI NIH HHS K23 HL092233
6 · The paper itself

Abstract

objectiveWhile >20% of patients presenting to the cardiac catheterization laboratory with angina have no obstructive coronary artery disease (CAD), a majority (77%) have an occult coronary abnormality (endothelial dysfunction, microvascular dysfunction (MVD), and/or a myocardial bridge (MB)). There are little data regarding the ability of noninvasive stress testing to identify these occult abnormalities in patients with angina in the absence of obstructive CAD.

methodsWe retrospectively evaluated 155 patients (76.7% women) with angina and no obstructive CAD who underwent stress echocardiography and/or electrocardiography before angiography. We evaluated Duke treadmill score, heart rate recovery (HRR), metabolic equivalents, and blood pressure response. During angiography, patients underwent invasive testing for endothelial dysfunction (decrease in epicardial coronary artery diameter >20% after intracoronary acetylcholine), MVD (index of microcirculatory resistance ≥25), and intravascular ultrasound for the presence of an MB.

resultsStress echocardiography and electrocardiography were positive in 58 (43.6%) and 57 (36.7%) patients, respectively. Endothelial dysfunction was present in 96 (64%), MVD in 32 (20.6%), and an MB in 83 (53.9%). On multivariable logistic regression, stress echo was not associated with any abnormality, while stress ECG was associated with endothelial dysfunction. An abnormal HRR was associated with endothelial dysfunction and MVD, but not an MB.

conclusionConventional stress testing is insufficient for identifying occult coronary abnormalities that are frequently present in patients with angina in the absence of obstructive CAD. A normal stress test does not rule out a non-obstructive coronary etiology of angina, nor does it negate the need for comprehensive invasive testing.

Indexed as

AdultAgedAngina PectorisCoronary Artery DiseaseEchocardiography, StressElectrocardiographyExercise TestFemaleHumansMaleMicrocirculationMiddle AgedRetrospective StudiesAnginaCoronary artery diseaseEchocardiographyElectrocardiography

Identifiers

PMID30527992
PMCPMC9017854
OpenAlexW2896996553

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.