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

The results from the step-wise loading test to 75 per cent of the age maximum pulse rate, performed by veloergemeter or thread-mill in 52 patients (9 females and 43 males, II of them with atypical chest pain and II with stenocardia) were juxtaposed to the data from the selective coronarography. It was established that the a reduction of ST segment greater than I mm and the appearance of precordial pain, degree III by the five-grade scale, have almost identical specificity (70% and 64% resp) and a predicting value of the positive result (68% and 70% resp) and a slightly higher sensitivity to pain (68% and 84% resp) in the detection of coronary stenosis greater than 50 per cent of the diameter of a main coronary vessel. The combination of the signs precordial pain degree III and/or ST reduction greater than I mm and/or elevation of ST greater than 2 mm, with same predicting value (67%) maintained, but with a considerably enhanced sensitivity (96%) proved to be most adequate as a criterion of the positive test. A reduction of ST segment greater than 22 mm is characterized by decrease of sensitivity (40%) but with a considerable increase of specificity (96%). The positivation of that sign suggests the presence mainly of a multibranch disease. The patients with coronary stenosis greater than 50%, rarely reach a physical capacity over 100 wt (7 x oxygen consumption) and a product of the maximum reached pulse rate and systolic blood pressure over 20 000 as compared with those without stenosis, but no difference among the patients with one-branch and multi-branch disease was established. The electrocardiographic changes in the patients with a true positive test with loading is more often retained after 4th minute of the rehabilitation phase as compared with those of the patients with false-positive test. Evidence exists to admit that the predicting value of the positive test is poorer in the patients with atypical pains and females.