[Comparison between the loading test and selective coronary angiography in stenocardia]

Area of Science:

• Cardiology
• Exercise Physiology

Background:

• Coronary artery stenosis detection is crucial for cardiovascular health.
• Exercise stress testing is a common diagnostic tool.

Purpose of the Study:

• To evaluate the diagnostic accuracy of exercise stress test parameters for detecting coronary artery stenosis.
• To compare the sensitivity and specificity of ST segment changes and precordial pain in identifying significant coronary artery disease.

Main Methods:

• Step-wise exercise loading tests (veloergometer or treadmill) to 75% of age-predicted maximum heart rate in 52 patients.
• Juxtaposition of exercise test results with selective coronarography data.
• Analysis of ST segment depression/elevation and precordial pain severity.

Main Results:

• ST segment depression >1mm and precordial pain (grade III) showed similar specificity (70%, 64%) and positive predictive value (68%, 70%) for >50% coronary stenosis.
• A combination of precordial pain (grade III) and/or ST depression (>1mm) and/or ST elevation (>2mm) achieved 96% sensitivity with 67% predictive value.
• ST segment depression >2mm indicated multi-branch disease with high specificity (96%) but lower sensitivity (40%).
• Reduced physical capacity and heart rate-blood pressure product were observed in patients with >50% stenosis.
• Delayed resolution of ECG changes post-exercise suggested true positive tests.

Conclusions:

• Combined exercise test parameters significantly enhance sensitivity for detecting coronary artery stenosis.
• ST segment depression >2mm is a specific indicator of multi-branch coronary artery disease.
• Predictive value of exercise tests may be lower in patients with atypical chest pain and females.