Coronary CT angiography in asymptomatic middle-aged athletes with ST segment anomalies during maximal exercise test

The clinical significance of ST segment anomalies occurring during exercise test in asymptomatic subjects is still debated. We designed a cross-sectional study to evaluate if the presence of these exercise test abnormalities were related with coronary CT angiography findings. Nine hundred forty athletes (range 30 to 60 years old), performed a maximal exercise test for sport eligibility. Forty-six subjects (4.9%) showing ST abnormalities during exercise and/or the recovery phase were referred to a 64-slice coronary computed tomography (CT) angiography. Among 44 subjects who underwent coronary CT angiography, 23 had an equivocal while 21 had a positive exercise test. Coronary CT angiography found, six and eight subjects with significant and not significant coronary artery disease, respectively. Further, seven patients demonstrated origin and course coronary anomalies. The positive predictive value for significant coronary artery disease of the exercise test was 13.6%. Our data suggest the referral to coronary CT angiography even of patients with equivocal repolarization anomalies during exercise and its recovery phase. Although the positive predictive value of a maximal exercise test in asymptomatic athletes appears lower than what observed in patients at high risk for coronary artery disease, about half of athletes with equivocal or positive exercise test demonstrated some coronary abnormalities.