Does chest shape influence exercise stress echocardiographic results in patients with suspected coronary artery disease?

Raw data related to the article Abstract<br> Despite the good specificity of exercise stress echocardiography (ESE) for the detection of coronary artery disease (CAD),<br> false positive (FP) results may occur. We have previously reported that chest abnormalities may affect parameters of cardiac<br> contractility. The influence of chest shape on ESE results has never been previously investigated. We retrospectively analyzed<br> 160 consecutive patients (64.4 ± 13.0-year old, 91 women) who had undergone coronary angiography at our Institution<br> because of positive ESE, between June 2014 and May 2020. Modified Haller index (MHI; chest transverse diameter over<br> the distance between sternum and spine) was assessed in all patients. Obstructive CAD was diagnosed by ≥ 70% stenosis<br> in any epicardial coronary artery. Outcome was false-positivity at ESE. 80.6% of patients were diagnosed with obstructive<br> CAD, while 19.4% had no CAD (FP). We separately analyzed patients with normal chest shape (MHI ≤ 2.5) and those with<br> concave-shaped chest wall (MHI &gt; 2.5). These latter were mostly women with small cardiac chambers, mitral valve prolapse<br> (MVP) and exercise-induced ST-segment changes. Likelihood of false-positivity was significantly higher in subjects with<br> MHI &gt; 2.5 than those with MHI ≤ 2.5 (30.7% vs 9.4%, p = 0.001). By multivariate logistic regression analysis, MHI &gt; 2.5<br> (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<br> territory (OR = 3.35, 95%CI 1.26–8.93, p = 0.01) were independently associated with false-positivity. Concave-shaped chest<br> wall (MHI &gt; 2.5) may be associated with false-positive stress echocardiographic result. Mechanisms underpinning this finding<br> need to be further explored.