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Published on: August 18, 2016
Approximately half of patients with coronary spastic angina had pathologic exercise tests
Shozo Sueda1, Toru Miyoshi1, Yasuhiro Sasaki1
1Department of Cardiology, Ehime Prefectural Niihama Hospital, Ehime, Japan.
Insights
Treadmill exercise tests (TETs) are clinically useful for diagnosing coronary spastic angina (CSA), with over a third of patients showing positive results. Pathological responses were observed in about half of the CSA patients studied.
Area of Science:
- Cardiology
- Diagnostic Medicine
Background:
- Coronary spastic angina (CSA) diagnosis can be challenging.
- Treadmill exercise tests (TETs) are a common diagnostic tool.
Purpose of the Study:
- To evaluate the clinical utility of TETs in diagnosing CSA.
- To assess the diagnostic yield of TETs in a cohort of CSA patients.
Main Methods:
- Treadmill exercise tests (TETs) and 24-hour Holter monitoring were performed on 300 patients with suspected CSA.
- Patients were categorized by angina type: rest, effort, or rest and effort.
- Presence of organic stenosis and spasm patterns were recorded.
Main Results:
- Positive TETs were observed in 38% of patients, with borderline results in 10%.
- Positive response rates were significantly higher in patients with organic stenosis (63.6%) compared to those without (33.2%).
- ST elevation during TETs was more frequent in patients with organic stenosis (27.3%) than without (1.2%).
Conclusions:
- Treadmill exercise tests are valuable for documenting ischemia in patients with CSA.
- Over one-third of CSA patients exhibit positive TET findings.
- A significant proportion of CSA patients demonstrate pathological responses on TETs.
Objectives:
We examined the clinical usefulness of treadmill exercise tests (TETs) in diagnosing coronary spastic angina (CSA).
Methods:
We performed the TETs and 24-h Holter monitoring in 300 CSA patients consisting of 152 patients with rest angina, 77 patients with effort angina, and 71 patients with rest and effort angina. Organic stenosis (>75%) was observed in 44 patients. Multiple spasms were recognized in 204 patients (68%).
Results:
Positive TETs were recognized in 113 patients (38%) and borderline was observed in 30 patients (10%). Positive response was significantly higher in patients with organic stenosis than those without fixed stenosis (63.6% vs. 33.2%, p<0.001). Moreover, ST elevation was more frequent in patients with organic stenosis than those without fixed stenosis (27.3% vs. 1.2%, p<0.001). Positive response in patients with effort angina (46.8%) was higher than those in patients with rest angina (33.6%) and rest and effort angina (36.6%), but not significant. Positive response was not different between single spasm and multiple spasms. In all 300 patients, ST segment elevation was observed in only four patients (1.3%) on the 24-h Holter monitoring.
Conclusions:
TET was useful in documenting ischemia in patients with CSA. More than a third of patients with CSA had positive TETs. Moreover, we obtained the pathologic TET response in approximately half of patients with CSA.
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