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EXERCISE TESTING AND LEFT MAIN CORONARY ARTERY DISEASE: EXPERIENCE WITH 57 PATIENTS

Bakr I. Salem1, Masahisa Terasawa, Virendra S. Mathur

  • 1Clayton Foundation for Research Laboratory, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas.

Cardiovascular Diseases
|December 1, 1978
PubMed

Insights

Multistage treadmill tests (TMT) are rarely negative for patients with left main (LM) coronary artery stenosis. A strongly positive TMT, especially with early ST depression, suggests LM disease and can predict lesion severity.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Exercise Physiology

Background:

  • Critical stenosis of the left main (LM) coronary artery poses a significant risk.
  • The diagnostic utility of exercise stress testing in patients with suspected LM disease requires further elucidation.

Purpose of the Study:

  • To analyze the results of multistage treadmill tests (TMT) in patients with critical left main coronary artery (LMCA) stenosis.
  • To determine the sensitivity and specificity of TMT in detecting ischemia in this patient population.
  • To identify predictors of exercise test positivity and severity of LM lesions.

Main Methods:

  • Retrospective analysis of TMT results from 57 patients with critical (>= 50%) LMCA stenosis.
  • Evaluation of ST segment depression, exercise tolerance, heart rate, blood pressure, and arrhythmias during TMT.
  • Correlation of TMT findings with the extent of coronary artery disease.

Main Results:

  • TMT was positive for ischemia in 89% of patients, with 70% showing a strongly positive response (>= 2 mm ST depression).
  • Early ST segment depression in stages I and II of the Bruce protocol was observed in a significant proportion of patients, often without chest pain.
  • Limited exercise tolerance and exercise-induced hypotension were noted, with arrhythmias occurring in 10% of patients.

Conclusions:

  • Treadmill testing is a valuable tool for diagnosing ischemia in patients with LMCA stenosis, rarely yielding negative results.
  • An early, strongly positive TMT response, particularly with ST depression in early stages, is highly suggestive of LM disease.
  • Exercise-induced hypotension is uncommon, but limited exercise tolerance and early ST depression may predict the severity of LM lesions.

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