Prevalence of Cerebrovascular Disease in Patients with Coronary Artery Disease After Pharmacological Stress Test.

Authors

Eman M Abdelfattah, Muhammad S Muhammad Hagrass, Khalid A Elkhashab, Sameh E Sadek, Hassan M Ebeid, Lamya O A Salih, Najah M Al-Amri, Mostafa S Mostafa, Haytham S Ghareeb

Published in

Journal of the Saudi Heart Association. Volume 38. Issue 2. Pages 19. Epub Jul 01, 2026.

Abstract

Coronary artery disease (CAD) and cerebrovascular disease (CVD) share common atherosclerotic pathways. However, the clinical significance of headache absence during stress testing remains unexplored. We investigated whether the absence of headache during pharmacological stress testing reflects the presence of subtle cerebrovascular atherosclerosis detectable by transcranial Doppler ultrasonography (TCD).
This cross-sectional study enrolled 225 patients with CAD undergoing pharmacological stress testing with TCD and myocardial perfusion imaging (MPI) at centers in Egypt (Cardiology Department, Fayoum University). Patients were stratified by headache status during stress testing. Multivariate logistic regression and receiver-operating characteristic (ROC) analysis identified independent predictors of abnormal TCD findings.
The cohort comprised 123 patients without headache (mean age 59.0 ± 6.8 years) and 102 with headache (mean age 56.5 ± 4.5 years). TCD abnormalities were significantly more prevalent in patients without headache (81.3% vs 27.5%, p < 0.0001). On univariate analysis, age (p < 0.001), hypertension (p = 0.014), and positive MPI (trend, p = 0.191) were associated with abnormal TCD. After adjustment for between-cohort heterogeneity, multivariate analysis confirmed the absence of headache as the strongest independent predictor of TCD abnormality (adjusted odds ratio [aOR] = 0.09, 95% confidence interval [CI]: 0.04-0.19; 91% risk reduction; p < 0.001). Age was the only cardiovascular risk factor that retained independent significance (aOR = 1.09 per year; 95% CI: 1.03-1.16; p = 0.005). The full predictive model achieved excellent discrimination (area under the ROC curve (AUC) = 0.833; 95% CI: 0.780-0.884), with sensitivity of 68.0%, specificity of 86.6%, and positive predictive value (PPV) of 87.0%.
This is the first evidence of a paradoxical association in pharmacological stress testing: absence of Headache is strongly associated with advanced subclinical cerebrovascular disease. This finding challenges the conventional interpretation of stress-test symptomatology and suggests new strategies for identifying high-risk CAD patients with silent cerebrovascular atherosclerosis who warrant aggressive preventive therapy. The utility of stress-induced symptom (Headache) profiles for risk stratification warrants prospective validation.

PMID:
42602904
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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