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Ambulatory ECG monitoring and bicycle ergometry: correlation with findings on coronary arteriography
Insights
Ambulatory ECG monitoring (AEM) and bicycle ergometric testing (BET) effectively diagnose coronary artery disease. Concordant results from both AEM and BET accurately predict normal or advanced coronary pathology, aiding clinical decisions.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Precordial symptoms necessitate accurate diagnosis of coronary artery disease.
- Coronary arteriography is the gold standard but is invasive.
- Non-invasive tests are crucial for initial patient assessment.
Purpose of the Study:
- To compare the diagnostic accuracy of Ambulatory ECG Monitoring (AEM) and Bicycle Ergometric Testing (BET) in patients with precordial symptoms.
- To evaluate the correlation between AEM, BET, and coronary arteriography findings.
- To assess the utility of combined AEM and BET in identifying coronary artery pathology.
Main Methods:
- 48 patients with precordial symptoms underwent Ambulatory ECG Monitoring (AEM) and multistage submaximal Bicycle Ergometric Testing (BET).
- Results were compared with findings from coronary arteriography.
- Discrepancies between AEM and BET were analyzed.
Main Results:
- Normal AEM and BET predicted normal coronary arteries in 18 of 20 patients.
- Abnormal AEM and BET indicated severe coronary pathology in 20 of 23 patients.
- Concordant results between AEM and BET showed fewer false positives/negatives than BET alone.
Conclusions:
- Normal AEM and BET strongly suggest normal coronary arteries.
- Positive AEM and BET results correlate highly with advanced coronary artery disease.
- Combined AEM and BET offer a reliable, non-invasive approach to evaluating coronary artery disease, with AEM providing safety benefits.
Abstract:
Ambulatory ECG monitoring during everyday activities (AEM) and a multistage submaximal bicycle ergometric test (BET) was performed on a series of 48 patients suffering from precordial symptoms or pain. The results of these tests were compared with the results of coronary arteriography. In 20 subjects with a negative AEM and BET the coronary arteriography was normal in 18, moderately pathological (30-60% narrowing) in 1, and severely pathological (greater than 60% narrowing) in another. In 23 subjects in whom both AEM and BET disclosed ST-T alterations, 20 had severely pathological and 1 moderately pathological coronary arteriograms; normal coronary arteries were found in only 2 subjects. Only 5 of the total of 48 patients of the series showed a discrepancy between the results of AEM and BET. The findings on coronary arteriography confirmed that patients with a normal AEM and BET have a very high probability of having normal coronary arteries, while if both tests are positive the patient will most likely have advanced coronary pathology. When the two tests were concordant, the number of false positive and false negative results were slightly less than if ergometry was performed alone. Although AEM does not provide the quantitative aspect of effort testing, it does have the advantage of avoiding the risk of unusual physical effort for the patient.