Clinical Profile and Stress Echocardiographic Findings at a Tertiary Cardiac Center in Pakistan: A Retrospective Cross-Sectional Study

Abstract

Objectives: To describe the demographic and clinical profile of patients undergoing stress echocardiography and to evaluate the distribution of stress echocardiographic findings in a tertiary cardiac care setting. Methodology: This single-center, retrospective, cross-sectional descriptive study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi, between November 2022 and October 2023. Adult patients undergoing treadmill stress echocardiography (TSE) or dobutamine stress echocardiography (DSE) for ischemia or viability assessment were included. Data were extracted from institutional records and included demographic variables, cardiovascular risk factors, hemodynamic parameters, pretest probability (Diamond–Forrester model), electrocardiographic changes, ejection fraction (EF), and Wall Motion Score Index (WMSI). Logistic regression analysis was performed to identify factors associated with positive stress echocardiography findings. Results: Among 342 patients (mean age 51.8 ± 11.3 years; 64.6% female), 10.5% demonstrated inducible ischemia on stress echocardiography. Dobutamine stress echocardiography was more frequently performed (68.1%) than treadmill testing (31.9%). Positive stress tests were significantly associated with higher diastolic blood pressure, chest pain during stress, electrocardiographic changes, prior ischemic heart disease, and intermediate pretest probability. On multivariable logistic regression, intermediate pretest probability remained independently associated with positive findings (OR 2.73, 95% CI 1.27–5.86; p = 0.01). Conclusion: In this tertiary care cohort, the majority of stress echocardiography studies were negative, with inducible ischemia identified in 10.5% of patients. Intermediate pretest probability emerged as the strongest independent determinant of positive findings. These results underscore the importance of appropriate patient selection to optimize diagnostic yield and support the clinical utility of stress echocardiography in resource-constrained settings.