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Correlation between resting ST segment depression, exercise testing, coronary angiography, and long-term prognosis
C P Miranda1, K G Lehmann, V F Froelicher
1Cardiology Department, Long Beach Veterans Affairs Medical Center, CA 90822.
Insights
Resting ST segment depression is a significant indicator of severe coronary artery disease, especially in patients with a prior myocardial infarction. This finding highlights its importance in cardiac risk assessment and diagnostic strategies.
Area of Science:
- Cardiology
- Clinical Electrocardiography
- Diagnostic Imaging
Background:
- Resting ST segment depression is a known marker for adverse cardiac events.
- Its correlation with exercise testing and coronary angiography requires further investigation.
Purpose of the Study:
- To correlate resting ST segment depression with exercise test results and coronary angiography findings.
- To assess the impact of resting ST segment depression on long-term prognosis in patients with and without prior myocardial infarction.
Main Methods:
- Retrospective study of 476 patients undergoing exercise testing and coronary angiography.
- Exclusion criteria included women, left bundle branch block, left ventricular hypertrophy, digoxin use, prior revascularization, or significant valvular/congenital heart disease.
- Long-term follow-up averaged 45 months.
Main Results:
- 10% of patients without prior infarction and 15% with prior infarction showed resting ST segment depression.
- Patients with resting ST segment depression and prior infarction had a 2.5 times higher prevalence of severe coronary artery disease (43% vs. 17%) and larger postinfarction left ventricles.
- Exercise-induced ST depression ≥2 mm was a useful marker for diagnosing coronary disease in patients without prior infarction.
Conclusions:
- Resting ST segment depression is associated with a higher prevalence of severe coronary artery disease, particularly in patients with a history of myocardial infarction.
- This finding underscores the prognostic value of resting ST segment depression in cardiac risk stratification.
- Further research may refine the diagnostic utility of exercise-induced ST segment changes in conjunction with resting ECG findings.
Abstract:
Resting ST segment depression has been identified as a marker for adverse cardiac events in patients with and without known coronary artery disease. To correlate this with exercise testing, coronary angiography, and how it impacts on long-term prognosis, a retrospective study was performed on 476 patients, of whom 223 had no clinical or electrocardiographic evidence of prior myocardial infarction while 253 were survivors of an infarction. All patients performed a standard exercise test and underwent diagnostic coronary angiography within an average of 32 days of their exercise test (range 0 to 90 days). Exclusions were women, those with left bundle branch block, left ventricular hypertrophy, use of digoxin, previous revascularization procedures, or significant valvular or congenital heart disease. Long-term follow-up was carried out for an average of 45 months (+/- 17). Of the patients without prior infarction, 23 (10%) had persistent resting ST segment depression, and of those with a prior history of infarction, 37 (15%) also had resting ST segment depression. Patients with resting ST segment depression and no prior myocardial infarction had a higher prevalence of severe coronary disease (three-vessel and/or left main) (30%) than those without resting ST segment depression (16%) (95% confidence interval [CI] for observed difference -5.0% to 33.9%, p = 0.12). The criterion of greater than or equal to 2 mm of additional exercise-induced ST segment depression was a particularly useful marker in these patients for the diagnosis of any coronary disease (likelihood ratio 3.35, 95% CI 0.56 to 19.93, p = 0.06). Patients with resting ST segment depression and a prior myocardial infarction had a 2.5 times higher prevalence of severe coronary artery disease compared with patients without resting ST segment depression (43% versus 17% prevalence, respectively, 95% CI for observed difference 9.38% to 42.8%, p less than 0.001) and also had larger left ventricles postinfarction (left ventricular end-diastolic volume index 102 ml/m2 compared with 96 ml/m2, p less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)