ArticleInternal and emergency medicine2022
Does chest shape influence exercise stress echocardiographic results in patients with suspected coronary artery disease?
Article in Internal and emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.
- Echocardiographic assessment of left ventricular mechanics in individuals with mitral valve prolapse: a systematic review and meta-analysis.The international journal of cardiovascular imaging · 2024Pooled it
- Mitral Valve Prolapse and Anxiety Disorders: A Systematic Review of Evidence in Both Directions and Meta-Analysis.Journal of clinical medicine · 2026Review
- From Modified Haller Index to a Novel Patented Anatomical Measurement Device: Engineering Development, Validation, and Clinical Applications of Non-Invasive Thoracic Morphometry.Bioengineering (Basel, Switzerland) · 2026Review
- Alignment Between Cardiologists and AI-Driven Diagnostic Systems: Mixed Methods Study.Journal of medical Internet research · 2026Article
- Rule-based clinical decision support system for automated assessment of left ventricular diastolic function during stress echocardiography.Frontiers in health services · 2026Article
- Diagnostic Accuracy of Exercise Stress Testing, Stress Echocardiography, Myocardial Scintigraphy, and Cardiac Magnetic Resonance for Obstructive Coronary Artery Disease: Systematic Reviews and Meta-Analyses of 104 Studies Published from 1990 to 2025.Journal of clinical medicine · 2025Review
- Right Ventricular Diastolic Dysfunction Before Coronary Artery Bypass Grafting: Impact on 5-Year Follow-Up Outcomes.Journal of clinical medicine · 2025Article
- Echocardiographic Assessment of Mitral Valve Prolapse Prevalence before and after the Year 1999: A Systematic Review.Journal of clinical medicine · 2024Review
- Article
- Risk factors identification of COVID-19 patients with chronic obstructive pulmonary disease: A retrospective study in Punjab-Pakistan.Immunity, inflammation and disease · 2023Article
- Imaging of heart disease in women: review and case presentation.European journal of nuclear medicine and molecular imaging · 2022Review
- Influence of chest wall conformation on spirometry parameters and outcome in mild-to-moderate idiopathic pulmonary fibrosis.Internal and emergency medicine · 2022Article
- Chest Shape Influences Ventricular-Arterial Coupling Parameters in Infants with Pectus Excavatum.Journal of cardiovascular echographyArticle
- Impact of Chest Wall Conformation on the Outcome of Primary Mitral Regurgitation due to Mitral Valve Prolapse.Journal of cardiovascular echographyArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite the good specificity of exercise stress echocardiography (ESE) for the detection of coronary artery disease (CAD), false positive (FP) results may occur. We have previously reported that chest abnormalities may affect parameters of cardiac contractility. The influence of chest shape on ESE results has never been previously investigated. We retrospectively analyzed 160 consecutive patients (64.4 ± 13.0-year old, 91 women) who had undergone coronary angiography at our Institution because of positive ESE, between June 2014 and May 2020. Modified Haller index (MHI; chest transverse diameter over the distance between sternum and spine) was assessed in all patients. Obstructive CAD was diagnosed by ≥ 70% stenosis in any epicardial coronary artery. Outcome was false-positivity at ESE. 80.6% of patients were diagnosed with obstructive CAD, while 19.4% had no CAD (FP). We separately analyzed patients with normal chest shape (MHI ≤ 2.5) and those with concave-shaped chest wall (MHI > 2.5). These latter were mostly women with small cardiac chambers, mitral valve prolapse (MVP) and exercise-induced ST-segment changes. Likelihood of false-positivity was significantly higher in subjects with MHI > 2.5 than those with MHI ≤ 2.5 (30.7% vs 9.4%, p = 0.001). By multivariate logistic regression analysis, MHI > 2.5 (OR 4.04, 95%CI 1.45-11.2, p = 0.007), MVP (OR 3.47, 95%CI 1.32-9-12, p = 0.01) and dyssynergy in the left circumflex territory (OR = 3.35, 95%CI 1.26-8.93, p = 0.01) were independently associated with false-positivity. Concave-shaped chest wall (MHI > 2.5) may be associated with false-positive stress echocardiographic result. Mechanisms underpinning this finding need to be further explored.
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