An analysis of factors influencing electrocardiogram stress test for detecting coronary heart disease
1Department of Cardiology, General Hospital of Beijing Command, PLA, Beijing 100700, China.
Insights
Left ventricular hypertrophy and a history of hypertension or diabetes mellitus significantly influence electrocardiogram (ECG) stress test accuracy for detecting coronary heart disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Electrocardiogram (ECG) stress testing is a common diagnostic tool for coronary heart disease.
- Factors influencing the accuracy of ECG stress tests require further investigation to optimize diagnostic yield.
- Understanding these factors can improve the interpretation of stress test results in patients with chest pain.
Purpose of the Study:
- To identify key factors that influence the accuracy of electrocardiogram (ECG) stress tests in diagnosing coronary heart disease.
- To compare patient characteristics and baseline clinical data between false-positive and true-negative ECG stress test results.
Main Methods:
- Retrospective review of treadmill stress test and coronary angiogram (CAG) records from 435 patients with chest pain.
- Comparison of baseline ECG, echocardiogram, blood pressure response, and medical history (hypertension, diabetes) between groups with normal CAG but positive stress tests (false-positive) and negative CAG with negative stress tests (true-negative).
Main Results:
- Hypertension and diabetes mellitus were significantly more prevalent in the false-positive group (Group A) compared to the true-negative group (Group B).
- Left ventricular (LV) hypertrophy, identified on baseline ECG and echocardiogram, was also significantly more common in the false-positive group.
- No significant differences were observed in maximal heart rate, blood pressure response during exercise, or other ECG parameters between the groups.
Conclusions:
- Left ventricular hypertrophy and a history of hypertension or diabetes mellitus are significant influencing factors for ECG stress test results.
- These factors appear to contribute to false-positive stress test outcomes in the absence of significant coronary artery disease.
- The findings highlight the importance of considering these patient characteristics when interpreting ECG stress tests.
Objective:
To evaluate factors influencing electrocardiogram (ECG) stress test.
Methods:
The treadmill stress test and coronary angiogram (CAG) records were reviewed retrospectively in 435 consecutive patients with chest pain between 1991 and 1997. There were 44 cases with normal CAG but positive exercise stress test results (false-positive, Group A), and 33 cases with both negative CAG and negative exercise test (true-negative, Group B). The baseline ECG, echocardiogram, abnormal systolic blood pressure response and history of diabetes mellitus and hypertension in the two groups were compared.
Results:
There was no significant difference between the two groups with respect to age, gender, and antianginal medication. More patients in Group A had hypertension (52.3% vs 27.3%, P < 0.05) and diabetes mellitus (15.9% vs 0%, P < 0.05). Left ventricular (LV) hypertrophy in baseline ECG and by echocardiogram was more often present in Group A (25.0% vs 3.0%, P < 0.05; 36.4% vs 12.1%, P < 0.05). There were no significant differences between the two groups with respect to maximal heart rate, maximal systolic blood pressure (BP), metabolic equivalents, postexercise systolic BP, termination for exercise test, baseline ECG with bundle branch block and ST depression.
Conclusion:
Our results suggest that LV hypertrophy and a history of hypertension or diabetes mellitus are the main factors influencing ECG stress test for detecting coronary heart disease.
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