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Detecting coronary artery disease among the individuals with left-sided dominant coronary circulation

Majid Saraei Koushki1, Bahram Sohrabi1, Razieh Parizad1

  • 1Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Caspian Journal of Internal Medicine
|April 29, 2026
PubMed

Insights

Exercise tolerance tests (ETT) may yield false positives in diabetic patients with left coronary dominance (LD). This highlights the importance of considering coronary circulation patterns and patient factors in diagnosing coronary artery disease (CAD).

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Preventive Medicine

Background:

  • Coronary artery disease (CAD) diagnosis relies on various methods.
  • Exercise tolerance tests (ETT) are commonly used but their accuracy can be influenced by coronary circulation patterns.
  • Left-sided dominant coronary circulation (LD) is a specific anatomical variation that may impact ETT results.

Purpose of the Study:

  • To investigate the diagnostic relevance of ETT in patients with coronary artery disease (CAD).
  • To analyze the impact of left-sided dominant coronary circulation on ETT accuracy.
  • To explore potential confounding factors such as diabetes mellitus in ETT interpretation.

Main Methods:

  • Retrospective analysis of 2084 patients undergoing ETT and coronary angiography (2018-2019).
  • Data analysis using SPSS version 16.
  • Evaluation of coronary circulation patterns including right coronary dominance (RD) and left coronary dominance (LD).

Main Results:

  • Left coronary dominance (LD) was present in 24.8% of patients.
  • The sensitivity of ETT for CAD detection was 94%.
  • The accuracy and diagnostic power of ETT for CAD in individuals with LD were 53% (p=0.03), suggesting lower reliability in this subgroup.

Conclusions:

  • Exercise tolerance tests (ETT) may have reduced accuracy in individuals with left coronary dominance (LD).
  • Diabetic individuals with LD showed a higher frequency of false-positive ETT results.
  • These findings emphasize the need to consider coronary anatomy and comorbidities for accurate CAD diagnosis.
Abstract

Keywords:
Coronary artery involvement severityCoronary artery syndromeExercise tolerance testLeft coronary blood circulation dominance

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