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Multiple lead ECG submaximal treadmill exercise tests in angiographically documented coronary heart disease
S C Tucker1, V E Kemp, W E Holland
1Health Sciences Division, Virginia Commonwealth University, Richmond 23298.
Insights
Submaximal exercise tolerance testing can help diagnose coronary artery disease. Using multiple ECG leads improves diagnostic accuracy, but failure to reach target heart rate leads to indeterminate results.
Area of Science:
- Cardiology
- Diagnostic Testing
- Exercise Physiology
Background:
- Submaximal exercise tolerance testing is a common diagnostic tool for coronary artery disease.
- The interpretation of exercise test results can be challenging, particularly in cases of indeterminate outcomes.
Purpose of the Study:
- To evaluate the diagnostic accuracy of submaximal exercise tolerance testing for coronary artery disease.
- To compare the effectiveness of multiple electrocardiographic (ECG) leads versus a single lead (V5) in detecting positive exercise tests.
- To assess the impact of target heart rate criteria on test results and diagnostic sensitivity.
Main Methods:
- One hundred patients underwent submaximal exercise tolerance testing and coronary cineangiography.
- Exercise test results were categorized as diagnostic (positive or negative) or indeterminate.
- Ventricular premature beats and ventricular asynergy were assessed.
- Diagnostic responses from multiple ECG leads were compared to a single lead (V5).
- The application of age-adjusted target heart rate criteria was analyzed for patients with indeterminate results.
Main Results:
- Sixty-six percent of exercise tests were diagnostic (48 positive, 18 negative); 34 patients had indeterminate results.
- Ventricular asynergy was significantly more frequent in patients with positive exercise tests (p < .0001).
- Exercise-induced ventricular premature beats were not related to significant coronary artery disease.
- Using multiple ECG leads significantly increased positive diagnostic responses compared to a single lead (p < .0001).
- Applying age-adjusted target heart rate criteria to indeterminate cases resulted in six false negative tests, lowering sensitivity.
Conclusions:
- Submaximal exercise tolerance testing is a valuable tool for diagnosing coronary artery disease, with ventricular asynergy being a key indicator.
- A multiple ECG lead system significantly enhances the diagnostic yield of exercise tests compared to a single lead.
- Failure to achieve target heart rate frequently leads to indeterminate results, necessitating careful interpretation and potentially alternative diagnostic strategies.
Abstract:
One hundred patients underwent submaximal exercise tolerance testing and coronary cineangiography. Sixty-six percent of the exercise tests were diagnostic including 48 positive and 18 negative tests; 34 patients had indeterminate test results. The occurrence of exercise induced ventricular premature beats was not related to significant coronary artery disease. Ventricular asynergy was significantly more frequent in patients with positive exercise tests (p less than .0001). Application of the age-adjusted target heart rate criterion recommended from Scandinavia and Myrtle Beach to patients with indeterminate results due to failure to reach target heart rate resulted in six false negative tests and lowered sensitivity. The number of positive diagnostic responses achieved using a multiple electrocardiographic lead system was compared with positive diagnostic responses detected in a single lead (V5) and the number of positive tests identified by the additional leads was highly significant (p less than .0001). A high incidence of indeterminate test results due to failure to achieve target heart rate is noted.