ArticleJournal of the American College of Cardiology2024
Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary Microvascular Function.
Article in Journal of the American College of Cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 1 of them a synthesis that pooled it.
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42 citing papers in PubMed, 1 synthesis or guideline pooled it, 76 citations in OpenAlex.
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- Paradoxical ST-segment depression at high blood flow in ANOCA: a hypothesis-generating analysis.The international journal of cardiovascular imaging · 2026Article
- Association between Chinese herbal medicine and the composite outcome of repeat revascularization and in-stent restenosis in patients with chronic coronary syndrome undergoing percutaneous coronary intervention: a prospective cohort study.Journal of geriatric cardiology : JGC · 2026Article
- Machine learning-enabled ECG arrhythmia classification: a systematic and educational study from signal processing to decision support.Scientific reports · 2026Article
- Intracoronary Electrocardiography During Dobutamine Stress for Functional Assessment of Myocardial Bridging.JACC. Case reports · 2026Article
- Diagnostic performance of exercise stress testing findings and coronary microvascular dysfunction in patients with angina with non-obstructive coronary artery disease.Heart (British Cardiac Society) · 2026Article
- Advanced detection of coronary artery disease using a GAN-transformer model on plasma cytokine profiles.Scientific reports · 2026Article
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- Symptom phenotypes and coronary microvascular function in non-obstructive coronary artery disease: Insights beyond epicardial ischemia.American heart journal plus : cardiology research and practice · 2026Article
- Coronary Microvascular Dysfunction in Cardiomyopathies: Insights on Clinical and Prognostic Roles.Reviews in cardiovascular medicine · 2026Review
- AI Characterisation of Discordance Profiles Between Stress Electrocardiogram and Myocardial Tomoscintigraphy Using Random Forest XGBoost and SHAP.Medical devices (Auckland, N.Z.) · 2026Article
- Coronary computed tomography angiography in patients with suspected coronary artery disease and discordant findings on exercise stress echocardiography.The international journal of cardiovascular imaging · 2025Article
- From Intracoronary Physiology to Endotype-Based Treatment: Quality of Life Improvement for INOCA Patients.Journal of clinical medicine · 2025Article
- Deep learning prediction of peak oxygen uptake in patients with coronary heart disease: a retrospective study.BMJ open · 2025Article
- Association of myocardial bridging with exercise-induced ischemia in patients without obstructive coronary artery disease.The international journal of cardiovascular imaging · 2025Article
- 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
- Multimodality Imaging for Diagnosis of Ischemic Heart Disease in Latin American Women from IAEA (International Atomic Energy Agency) Collaboratory.Current cardiology reports · 2025Review
- Exercise electrocardiography stress testing in suspected angina and non-obstructive coronary arteries.European heart journal · 2025Article
- New avenues for the assessment of stable ischemic heart disease.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Review
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Authors and funding
15 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundExercise electrocardiographic stress testing (EST) has historically been validated against the demonstration of obstructive coronary artery disease. However, myocardial ischemia can occur because of coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease.
objectivesThe aim of this study was to assess the specificity of EST to detect an ischemic substrate against the reference standard of coronary endothelium-independent and endothelium-dependent microvascular function in patients with angina with nonobstructive coronary arteries (ANOCA).
methodsPatients with ANOCA underwent invasive coronary physiological assessment using adenosine and acetylcholine. CMD was defined as impaired endothelium-independent and/or endothelium-dependent function. EST was performed using a standard Bruce treadmill protocol, with ischemia defined as the appearance of ≥0.1-mV ST-segment depression 80 ms from the J-point on electrocardiography. The study was powered to detect specificity of ≥91%.
resultsA total of 102 patients were enrolled (65% women, mean age 60 ± 8 years). Thirty-two patients developed ischemia (ischemic group) during EST, whereas 70 patients did not (nonischemic group); both groups were phenotypically similar. Ischemia during EST was 100% specific for CMD. Acetylcholine flow reserve was the strongest predictor of ischemia during exercise. Using endothelium-independent and endothelium-dependent microvascular dysfunction as the reference standard, the false positive rate of EST dropped to 0%.
conclusionsIn patients with ANOCA, ischemia on EST was highly specific of an underlying ischemic substrate. These findings challenge the traditional belief that EST has a high false positive rate.
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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.