Exercise body surface potential mapping in single and multiple coronary artery disease

Area of Science:

• Cardiology
• Medical Imaging
• Exercise Physiology

Background:

• Coronary artery disease (CAD) diagnosis and risk stratification are crucial for patient management.
• Assessing myocardial ischemia during exercise is vital, but symptoms like angina can be variable.
• Current methods may not fully capture the extent of ischemic risk, especially in asymptomatic patients.

Purpose of the Study:

• To evaluate the utility of body surface ST integral mapping for quantifying myocardial ischemic risk in CAD patients.
• To determine if this technique is effective irrespective of the presence or absence of exercise-induced angina.
• To explore the correlation between ST integral changes and CAD severity and perfusion.

Main Methods:

• Body surface ST integral maps were recorded in 36 CAD patients at rest, peak exercise, and during recovery.
• Maps were compared between patients with angina, those with exercise fatigue without angina, and normal subjects.
• Quantitative coronary angiography and thallium perfusion scores were used for correlation.

Main Results:

• Patients with two and three-vessel CAD showed significantly greater ST integral decreases during angina-limited exercise compared to single-vessel CAD.
• CAD patients experiencing exercise fatigue without angina had ST integral decreases similar to single-vessel CAD patients with angina.
• Persistent ST integral decreases were observed in all CAD patients at 5 minutes of recovery, correlating with peak exercise changes and quantitative angiographic scores.

Conclusions:

• Exercise ST integral body surface mapping effectively quantifies myocardial ischemic risk in CAD patients.
• The technique provides valuable risk assessment regardless of whether patients experience ischemic symptoms during exercise.
• This method holds potential for guiding CAD therapy selection through quantitative assessment of ischemic myocardial risk.