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Diagnostic Performance of the Master Double 2-Step Exercise Electrocardiogram for Detecting Coronary Microvascular

Tsuyoshi Ito1, Masashi Yokoi1, Shuichi Kitada1

  • 1Department of Cardiology, Nagoya City University.

Circulation Journal : Official Journal of the Japanese Circulation Society
|September 17, 2025
PubMed

Insights

The Master double 2-step exercise electrocardiogram (ECG) shows high specificity for diagnosing coronary microvascular dysfunction (CMD) in patients without obstructive coronary artery disease (CAD). This non-invasive test aids in identifying CMD, improving diagnostic accuracy.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Clinical Physiology

Background:

  • The diagnostic value of exercise electrocardiograms (ECG) for coronary microvascular dysfunction (CMD) is not well-established.
  • Coronary microvascular dysfunction (CMD) is a significant condition affecting cardiac health.

Purpose of the Study:

  • To evaluate the diagnostic utility of the Master double 2-step exercise ECG in detecting CMD.
  • To assess the accuracy of exercise ECG findings in patients with suspected CMD but without obstructive coronary artery disease (CAD).

Main Methods:

  • Analysis of 101 patients without obstructive coronary artery disease (CAD).
  • Utilized Master double 2-step exercise ECG combined with invasive coronary physiological assessment.
  • Calculated sensitivity, specificity, positive predictive value, and negative predictive value for ischemic ECG changes.

Main Results:

  • The Master double 2-step exercise ECG showed a specificity of 0.97 for detecting CMD.
  • Positive ECG findings significantly increased the post-test probability of CMD from 24.8% to 82.8%.
  • Sensitivity, PPV, and NPV were 0.44, 0.85, and 0.84, respectively.

Conclusions:

  • The Master double 2-step exercise ECG is a highly specific tool for identifying CMD in patients lacking obstructive CAD.
  • Exercise ECG can be a valuable non-invasive method to aid in the diagnosis of CMD.
Abstract

Keywords:
Coronary microvascular dysfunctionDiagnostic performanceExercise ECG

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