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Noninvasive detection of coronary artery disease in patients presenting with claudication
T N Sonecha1, A N Nicolaides, A M Salmasi
1Irvine Laboratory for Cardiovascular Investigation and Research, St. Mary's Hospital Medical School, London, U.K.
Insights
Electrocardiogram (ECG) chest wall mapping during bicycle ergometry effectively screens for coronary artery disease in claudication patients. This method identified high-risk individuals who may not show symptoms on a resting ECG, warranting further investigation.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Exercise Physiology
Background:
- Coronary artery disease (CAD) is a leading cause of morbidity and mortality.
- Claudication, often a symptom of peripheral artery disease, can coexist with CAD.
- Early detection of myocardial ischemia is crucial for timely intervention.
Purpose of the Study:
- To evaluate the utility of ECG chest wall mapping with bicycle ergometry in screening patients with claudication for ischemic heart disease.
- To assess the ability of this technique to identify individual coronary artery territories involved.
- To determine the prevalence of significant coronary artery disease in this patient cohort.
Main Methods:
- 100 consecutive patients presenting with claudication underwent ECG chest wall mapping during bicycle ergometry.
- Patients with a positive history or resting ECG evidence of ischemic heart disease were identified.
- ECG results were analyzed for ischemia detection and coronary artery territory involvement.
Main Results:
- The test was positive in 38 patients, negative in 38, and inconclusive in 24 due to inadequate heart rate response.
- In 29% of positive tests, no prior history or resting ECG evidence of ischemia was found.
- ECG findings suggested single-vessel disease in 16, two-vessel disease in 19, and three-vessel disease in 3 patients.
Conclusions:
- ECG chest wall mapping during bicycle ergometry is a valuable tool for screening claudication patients for myocardial ischemia.
- The technique identified a significant subset of high-risk patients (11%) with potential severe coronary artery disease who required coronary angiography.
- This method can detect ischemia and pinpoint affected coronary territories, aiding in risk stratification.
Abstract:
ECG chest wall mapping with bicycle ergometry which can detect not only myocardial ischaemia but also individual coronary artery territories involved has been used to screen 100 consecutive patients presenting with claudication. Fifty-three had a positive history and/or evidence of ischaemic heart disease on a resting ECG. The test was positive in 38, negative in 38 and inconclusive in 24, the latter because of inadequate heart rate response. In 11 out of 38 (29%) with a positive test there was no history or evidence of myocardial ischaemia on a conventional resting ECG. ECG changes suggestive of three vessel coronary disease were found in three, single vessel coronary disease in 16 and two vessel disease in 19. Of the latter, eight had changes in the LAD/circumflex distribution, indicating left main stem or equivalent disease. These together with the three with triple vessel coronary disease constituted a subset of 11 (11%) high risk patients who merited coronary angiography with a view to confirming the presence of severe coronary disease.