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Cardiopulmonary exercise testing is more accurate than ECG-stress testing in diagnosing myocardial ischemia in
Romualdo Belardinelli1, Francesca Lacalaprice1, Luca Tiano2
1Cardiologia Riabilitativa e Preventiva, Azienda Ospedali Riuniti Lancisi-Umberto I-Salesi, Ancona, Italy.
Insights
Cardiopulmonary exercise stress testing (CPET) significantly improves the accuracy of diagnosing obstructive coronary artery disease (O-CAD) in patients with chest pain compared to standard ECG stress testing. CPET is recommended as a primary diagnostic tool for better patient outcomes.
Area of Science:
- Cardiology
- Exercise Physiology
- Diagnostic Imaging
Background:
- Cardiopulmonary exercise stress testing (CPET) is vital for heart failure assessment.
- The diagnostic utility of CPET for obstructive coronary artery disease (O-CAD) in chest pain patients remains unclear.
- Standard ECG stress testing (ET) has limitations in diagnosing O-CAD.
Purpose of the Study:
- To evaluate if CPET enhances diagnostic accuracy for O-CAD compared to ET.
- To assess the predictive value of CPET in patients presenting with chest pain.
- To determine the role of CPET as a first-line diagnostic tool.
Main Methods:
- Prospective study of 1265 patients with chest pain undergoing both ET and CPET.
- Exclusion of patients with previously diagnosed O-CAD.
- Coronary angiography and nuclear SPECT imaging used for confirmation.
Main Results:
- CPET demonstrated significantly higher sensitivity (88% vs. 48%) and specificity (98% vs. 55%) than ET for O-CAD detection.
- Negative CPET results, particularly with high peak VO2 and no ischemia, excluded O-CAD with 100% accuracy.
- CPET positively predicted cardiac events (log rank 18.2, P<0.0001).
Conclusions:
- CPET offers superior diagnostic and predictive accuracy for myocardial ischemia compared to ET in chest pain patients.
- CPET should be considered a primary diagnostic tool in clinical practice for O-CAD evaluation.
- Improved diagnostic accuracy with CPET can guide clinical decision-making and improve patient management.
Background:
Cardiopulmonary exercise stress testing (CPET) is used to grade the severity of heart failure and to assess its prognosis. However it is unknown whether CPET may improve diagnostic accuracy of standard ECG stress testing to identify or exclude obstructive coronary artery disease (O-CAD) in patients with chest pain.
Methods:
We prospectively studied 1265 consecutive subjects (55 ± 8 years, 156 women) who were evaluated with ECG stress testing (ET) for chest pain. No one had a documented O-CAD. All patients performed an incremental CPET with ECG recordings on an electronically braked cycle ergometer.
Results:
Of 1265 patients, 73 had a positive CPET and 1192 had a negative CPET. Seventy-three patients with a positive CPET and 71 patients with a negative CPET agreed to undergo nuclear SPECT imaging and coronary angiography. Follow-up lasted 48 ± 7 months. As compared with ET, sensitivity, specificity, PPV and NPV were all improved significantly (ET: 48%, 55%, 33%, 95%; CPET: 88%, 98%, 73%, 99%, respectively, P<0.001). Patients with both peak VO2>91% of predicted VO2 max and absence of VO2-related signs of myocardial ischemia had no evidence of O-CAD in 100% of cases. Cardiac events occurred in 32 patients with a positive CPET and 8 patients with a negative CPET (log rank 18.2, P<0.0001).
Conclusions:
In patients with chest pain, CPET showed a better diagnostic and predictive accuracy than traditional ET to detect/exclude myocardial ischemia. Its use should be encouraged among physicians as a first line diagnostic tool in clinical practice.
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