Abstract
To the Editor: Recently, an article in Circulation discussed the prognostic utility of mental stress–induced wall motion abnormalities.1 The conclusion reached in the article is that the association between wall motion abnormalities during mental stress and mortality is important and probably underestimated by the unadjusted risk ratio of 2.79 (1.00 to 7.85). The authors suggest that investigations should be undertaken to determine whether a cheaper version of this test could be developed for the clinical setting. Before drawing such conclusions, alternative explanations of the findings need exploration. There were 17 deaths in this study. Wall motion abnormalities during the speech test were observed among 37 patients. A total of 6 patients were observed to have wall motion abnormalities during the speech test and then die within the follow-up period. Because the results of the paper were based on so few …
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