Exercise electrocardiogram in patients with normal and abnormal coronary arteriogram

Area of Science:

• Cardiology
• Diagnostic Imaging
• Exercise Physiology

Background:

• Coronary artery disease (CAD) diagnosis often relies on coronary arteriography.
• Non-invasive methods like exercise testing are crucial for initial assessment of effort angina.
• Accurate prediction of arteriogram findings from clinical and ECG data can optimize diagnostic pathways.

Purpose of the Study:

• To evaluate the predictability of normal versus abnormal coronary arteriograms.
• To assess the diagnostic value of patient history, exercise test symptoms, and post-exercise ECG changes.
• To identify reliable criteria for predicting significant coronary artery disease.

Main Methods:

• Seventy patients with chest pain suggestive of effort angina underwent exercise testing.
• Data collected included chest pain patterns during exercise and post-exercise electrocardiogram (ECG) changes.
• Sensitivity and specificity were calculated for combined clinical and ECG criteria against coronary arteriogram results.

Main Results:

• A combined criterion of increasing chest pain during exercise plus T wave biphasicity or prior myocardial infarction showed 81% sensitivity and 94% specificity.
• Replacing T wave biphasicity with ST depression did not improve diagnostic accuracy.
• Continuous increasing chest pain during exercise was the sole factor present in all patients with abnormal arteriograms.

Conclusions:

• Exercise testing combined with specific ECG findings, particularly T wave biphasicity, can reliably predict coronary arteriogram outcomes.
• The presence of continuously increasing chest pain during exercise is a strong indicator of significant coronary artery disease.
• Absence of this specific chest pain pattern may help in avoiding unnecessary coronary arteriographies in patients with normal findings.