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[Value of the negative U wave during exercise test in the diagnosis of coronary insufficiency]
Insights
U wave inversion during exercise stress tests shows higher specificity for diagnosing coronary insufficiency compared to anginal pain or ST depression. However, it has lower sensitivity and positive predictive value than ST depression for detecting coronary artery disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) diagnosis relies on stress tests and coronary angiography.
- Traditional stress test criteria include anginal pain and ST depression.
- The diagnostic value of U wave inversion during exercise remains under investigation.
Purpose of the Study:
- To evaluate the diagnostic utility of U wave inversion during exercise stress tests for coronary insufficiency.
- To compare the specificity, sensitivity, and predictive values of U wave inversion against anginal pain and ST depression.
Main Methods:
- Retrospective review of stress tests from 227 patients.
- Corrosion angiography performed to confirm coronary artery disease status.
- Analysis of U wave inversion, anginal pain, and ST depression during exercise.
Main Results:
- U wave inversion demonstrated higher specificity (82.8%) than anginal pain (77.4%) and ST depression (66.7%).
- Sensitivity for U wave inversion (26.9%) was lower than ST depression (80.6%) and anginal pain (56.7%).
- Positive predictive value for U wave inversion (70.9%) was comparable to ST depression (77.7%) and anginal pain (78.3%).
Conclusions:
- U wave inversion is a specific, though not highly sensitive, indicator for diagnosing coronary insufficiency.
- Its value in conjunction with other stress test parameters warrants further clinical consideration.
Abstract:
In order to determine the value of inversion of the U wave during exercise for the diagnosis of coronary insufficiency, the stress tests of 227 patients were reviewed and confronted with the results of coronary angiography which showed 93 subjects with angiographically normal arteries and 134 subjects with left anterior descending disease; 37 patients had single vessel disease (Group I), 38 had double vessel disease (Group II) and 59 had triple vessel disease (Group III). When compared to the two classical criteria, anginal pain and less than or equal to 1 mm ST depression, inversion of the U wave was more specific: 82.8 +/- 7.6 p. 100 vs 77.4 p. 100 for anginal pain, and 66.7 +/- 9.6 p. 100 for ST depression. The sensitivity of this new sign for the detection of coronary insufficiency was 26.9 +/- 7.5 p. 100 vs 80.6 +/- 6.7 p. 100 for ST depression and 56.7 +/- 8.4 p. 100 for anginal pain. The positive predictive value of U wave inversion on effort was 70.9 +/- 12 p. 100 compared to 77.7 +/- 6.9 p. 100 for ischaemic ST depression and 78.3 +/- 8.2 p. 100 for induced anginal pain. Conversely, in angiographically normal coronary arteries, the absence of U wave inversion had a negative predictive value of 44.8 +/- 7.4 p. 100 compared to 70.5 +/- 9.5 p. 100 for the absence of ischaemic ST changes and 55.4 +/- 8.5 for the absence of anginal pain. These results confirm previously published data.(ABSTRACT TRUNCATED AT 250 WORDS)