{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:41:35Z","timestamp":1784900495452,"version":"3.55.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Patients with abnormal (positive) exercise electrocardiography, but normal stress echocardiography (+ECG\/\u2212Echo), have an increased risk of adverse cardiovascular events compared with patients with a normal (negative) ECG and a normal stress Echo (\u2212ECG\/\u2212Echo). However, it is unclear if +ECG\/\u2212Echo discordance is associated with a greater burden of subclinical coronary atherosclerosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>Project Baseline Health Study participants who underwent a stress Echo and coronary artery calcium (CAC) scan were stratified by stress Echo result: \u2212ECG\/\u2212Echo or +ECG\/\u2212Echo. Multivariable regression investigated the association between stress Echo results and CAC burden. Event-free survival from a composite of adverse cardiovascular events was compared between groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Among 1630 asymptomatic participants in this observational cohort study, 1503 (92.2%) had a \u2212ECG\/\u2212Echo, 105 (6.4%) had a +ECG\/\u2212Echo, and 22 (1.3%) had a +Echo. The +ECG\/\u2212Echo group had a significantly greater burden of coronary atherosclerosis than the \u2212ECG\/\u2212Echo group (mean CAC score, 198\u00b1470 versus 53\u00b1186;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; CAC\n              <jats:sub>log<\/jats:sub>\n              , 2.2\u00b12.7 versus 1.2\u00b12.0;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). The \u2212ECG\/\u2212Echo group was more likely to have CAC=0 compared with the +ECG\/\u2212Echo group (65.9% versus 53.3%;\n              <jats:italic>P<\/jats:italic>\n              =0.01), whereas the +ECG\/\u2212Echo group more commonly had CAC \u2265100 (28.6% versus 11.4%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). After adjustment, CAC\n              <jats:sub>log<\/jats:sub>\n              scores were 52% higher in the +ECG\/\u2212Echo group than in the \u2212ECG\/\u2212Echo group (\n              <jats:italic>P<\/jats:italic>\n              =0.002). Compared with the \u2212ECG\/\u2212Echo group, the +ECG\/\u2212Echo group was 4.5\u00d7 more likely to have a CAC score \u2265400 (adjusted odds ratio, 4.54 [95% CI, 1.95\u201310.05];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). After a median follow-up of 4.3 years, a trend toward increased adverse cardiovascular events was observed among participants with +ECG\/\u2212Echo.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Individuals with a +ECG\/\u2212Echo have a higher burden of subclinical coronary atherosclerosis than those with a \u2212ECG\/\u2212Echo, which may explain, at least in part, the increased risk for adverse cardiac events in this population. Further study is needed to determine the optimal strategy for mitigating cardiovascular risk in these patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT03154346.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.124.017380","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T10:00:47Z","timestamp":1736762447000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Abnormal Exercise Electrocardiography With Normal Stress Echocardiography Is Associated With Subclinical Coronary Atherosclerosis"],"prefix":"10.1161","volume":"18","clinical-trial-number":[{"clinical-trial-number":"nct03154346","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5368-9564","authenticated-orcid":false,"given":"Jessica M.","family":"Duran","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (J.M.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Shrader","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute (P.S., C.H., G.B., A.H., S.H.S., P.S.D., M.A.D.), Duke University School of Medicine, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7056-9559","authenticated-orcid":true,"given":"Chuan","family":"Hong","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute (P.S., C.H., G.B., A.H., S.H.S., P.S.D., M.A.D.), Duke University School of Medicine, Durham, NC."},{"name":"Division of Cardiology, Department of Medicine (C.H., G.B., A.H., S.H.S., P.S.D., M.A.D.), Duke University School of Medicine, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Haddad","sequence":"additional","affiliation":[{"name":"Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (F.H., E.J.S., N.C., T.K., M.S., K.W.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6014-9857","authenticated-orcid":false,"given":"Everton J.","family":"Santana","sequence":"additional","affiliation":[{"name":"Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (F.H., E.J.S., N.C., T.K., M.S., K.W.M.)."},{"name":"Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (E.J.S., N.C., T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8059-7692","authenticated-orcid":true,"given":"Nicholas","family":"Cauwenberghs","sequence":"additional","affiliation":[{"name":"Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (F.H., E.J.S., N.C., T.K., M.S., K.W.M.)."},{"name":"Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (E.J.S., N.C., T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4293-4576","authenticated-orcid":false,"given":"Tatiana","family":"Kouznetsova","sequence":"additional","affiliation":[{"name":"Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (F.H., E.J.S., N.C., T.K., M.S., K.W.M.)."},{"name":"Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (E.J.S., N.C., T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Salerno","sequence":"additional","affiliation":[{"name":"Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (F.H., E.J.S., N.C., T.K., M.S., K.W.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7176-1611","authenticated-orcid":false,"given":"Gerald","family":"Bloomfield","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute (P.S., C.H., G.B., A.H., S.H.S., P.S.D., M.A.D.), Duke University School of Medicine, Durham, NC."},{"name":"Division of Cardiology, Department of Medicine (C.H., G.B., A.H., S.H.S., P.S.D., M.A.D.), Duke University School of Medicine, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne","family":"Koweek","sequence":"additional","affiliation":[{"name":"Department of Radiology (L.K.), Duke 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