Electrocardiographic criteria for detecting coronary artery disease in hypertensive patients with ST-segment changes
Andreas P Michaelides1, Charalampos I Liakos, Leonidas G Raftopoulos
11st University Department of Cardiology, Exercise Laboratory, Athens Medical School, Hippokration Hospital, Athens, Greece. michaelides@freemail.gr
Insights
Hypertensive patients with specific exercise-induced ST-segment depression patterns, particularly prolonged recovery, are more likely to have coronary artery disease (CAD). Absence of ST depression in certain leads or early recovery suggests a false positive.
Area of Science:
- Cardiology
- Exercise Physiology
- Diagnostic Imaging
Background:
- Arterial hypertension is linked to exercise-induced electrocardiographic changes that can mimic coronary artery disease (CAD).
- Accurate detection of CAD in hypertensive individuals with ischemic ST-segment responses is clinically significant.
Observation:
- A study analyzed 382 hypertensive patients undergoing exercise testing and coronary arteriography.
- 80% of patients with ischemic ST-segment changes on exercise testing had normal coronary arteries.
Findings:
- ST-segment depression in leads II-III-aVF and/or V(4)-V(6) during exercise, especially with prolonged depression in the recovery phase (4-8 minutes), was associated with a higher likelihood of significant coronary artery stenosis (63% vs 6% in those without these criteria).
- Absence of ST-segment depression in leads V(4)-V(5) at peak exercise or during early recovery (7-8 minutes) strongly suggested a false-positive exercise test result.
Implications:
- These findings suggest specific electrocardiographic criteria during exercise and recovery can improve the diagnostic accuracy for CAD in hypertensive patients.
- Identifying these criteria may help differentiate true CAD from false-positive exercise test results in this population.
Purpose:
It is well known that patients with arterial hypertension frequently present with ischemic electrocardiographic changes during exercise testing without actually having coronary artery disease (CAD). The purpose of this study was to establish additional electrocardiographic criteria during exercise testing for detecting CAD in hypertensive patients with ischemic ST-segment response.
Methods:
Three hundred eighty-two consecutive hypertensive patients (224 males, 58 +/- 8 years) who presented with ischemic electrocardiographic changes during exercise testing and agreed to undergo coronary arteriography were included in the study.
Results:
From 382 hypertensive patients undergoing coronary angiography, only 76 (20%) had significant coronary stenosis, whereas 306 (80%) had normal coronary arteries. From 382 patients, 287 (75%) (group A) presented with ST-segment depression during exercise in leads II-III-aVF-V(6), 271 (94%) of which had normal arteries at the angiography. The remaining 95 patients (25%) (group B) of the studied patients presented with ST-segment depression in II-III-aVF and/or V(4) through V(6), 60 (63%) of which had CAD. Furthermore, 251 patients of group A presented with ST-segment depression during the fourth to sixth minute of the recovery period in V(4) through V(6), 247 (98%) of which had normal arteries. Another 28 patients from group B presented with ST-segment depression during the fourth to eighth minute of the recovery period in V(4) through V(6), 22 (79%) of which had significant coronary artery stenosis.
Conclusions:
Hypertensive patients who present with ST-segment depression during exercise in leads II-III-aVF and/or V(4) through V(6) and with a prolonged duration of this depression at the recovery phase (fourth to eighth minute) are more likely to have CAD. Absence of ST-segment depression in V(4) and V(5) at the end of exercise or during the seventh and eighth minute of recovery favors a false-positive result.
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