Authors

• Eman Mahmoud Abdelfattah, Department of Cardiology, Fayoum University, Fayoum, Egypt
• Muhammad Salem Muhammad Hagrass, Department of Cardiology, Fayoum University, Fayoum, EgyptFollow
• Khalid Ahmed Elkhashab, Department of Cardiology, Fayoum University, Fayoum, Egypt
• Sameh Emil, Department of Cardiology, Military Medical Academy, Cairo, Egypt
• Hassan Mohamed Ebeid, Department of Cardiology, Fayoum University, Fayoum, Egypt
• Lamya Salih, Ministry of Health, Sharjah, United Arab Emirates
• Najah Makhbout Al-Amri, SEHA Clinics, Abu Dhabi, United Arab Emirates
• Mostafa Sayed, Department of Nuclear medicine, Assiut University, Assiut, Egypt
• Haytham Soliman Ghareeb, Department of Cardiology, Fayoum University, Fayoum, Egypt

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

Abstract

Objectives: 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).

Methods: 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.

Results: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

Conclusions: 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.

Recommended Citation

Abdelfattah, Eman Mahmoud; Hagrass, Muhammad Salem Muhammad; Elkhashab, Khalid Ahmed; Emil, Sameh; Ebeid, Hassan Mohamed; Salih, Lamya; Al-Amri, Najah Makhbout; Sayed, Mostafa; and Ghareeb, Haytham Soliman (2026) "Prevalence of Cerebrovascular Disease in Patients with Coronary Artery Disease After Pharmacological Stress Test," Journal of the Saudi Heart Association: Vol. 38 : Iss. 2 , Article 19.
Available at: https://doi.org/10.37616/2212-5043.1511

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