Evaluation of ST-segment changes during and after maximal exercise tests in one-, two- and three-vessel coronary
Thorvald Bjurö1, Lars Gullestad, Knut Endresen
1AstraZeneca R&D, Mölndal, Sweden. thorvald.bjuro@astrazeneca.com
Insights
Exercise stress tests can identify severe coronary artery disease. A shorter time to ST-depression and abnormal post-exercise heart rate recovery indicate three-vessel disease.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Coronary artery disease (CAD) diagnosis often relies on angiography.
- Exercise testing provides valuable data on cardiac function during physical stress.
Purpose of the Study:
- To correlate electrocardiogram (ECG) and heart rate (HR) variables during and after exercise with the extent of CAD (one-, two-, or three-vessel disease).
- To determine if exercise test parameters can predict the severity of coronary artery disease.
Main Methods:
- Seventy-three male patients with stable angina and confirmed CAD underwent maximal exercise testing.
- 12-lead ECG and HR data were analyzed using computer averaging at 10-second intervals.
- ST-amplitude and HR recovery loops were key variables measured.
Main Results:
- Univariate analysis showed patients with three-vessel disease had reduced exercise capacity and faster ST-depression onset.
- Multivariate analysis identified time to ST-depression as a discriminator between one- and three-vessel disease.
- Abnormal post-exercise ST/HR recovery patterns were more frequent in severe CAD.
Conclusions:
- A shorter time to ST-depression during exercise testing is linked to three-vessel disease.
- Abnormal post-exercise ST/HR recovery patterns are more prevalent in patients with more severe CAD.
Objective:
To relate ECG and heart rate (HR) variables during and after exercise testing with the presence of one-, two- or three-vessel disease defined by angiography.
Design:
Seventy-three male patients with stable angina pectoris and angiographically verified coronary artery disease underwent a maximal exercise test. From 12-lead ECG recordings and computer averaging ST-amplitude and HR data were measured in consecutive 10-s intervals.
Results:
In univariate analysis, patients with three-vessel disease had lower maximal exercise capacity, a shorter time to >1 mm ST-depression, more often a clockwise ST/HR recovery loop, more frequently a post-exercise downward ST-segment slope, and a greater ST-deficit at 3.5 min after exercise than patients with one-vessel disease. In multivariate analysis, time to >1 mm ST-depression discriminated between patients with three- and one-vessel disease. In patients with an intermediate time to >1 mm ST-depression a clockwise ST/HR recovery loop and/or a downsloping ST-segment in the post-exercise period were significantly more prevalent in severe vessel disease.
Conclusion:
Patients with three-vessel disease had a significantly shorter time to >1 mm ST-depression during exercise and more often an abnormal post-exercise ST/HR reaction than those with one-vessel disease.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:30Coronary Artery Disease III: Clinical Manifestations
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...