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Abnormal blood pressure response and marked ischemic ST-segment depression as predictors of severe coronary artery
Insights
Abnormal blood pressure response and marked ST-segment depression during exercise tests can help identify patients with severe coronary artery disease. These exercise test abnormalities are valuable indicators of advanced coronary artery disease.
Area of Science:
- Cardiology
- Exercise Physiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) diagnosis relies on invasive procedures like coronary arteriography.
- Non-invasive exercise testing provides valuable prognostic information for CAD patients.
- Predictive markers for severe CAD during exercise testing require further elucidation.
Purpose of the Study:
- To assess the diagnostic utility of abnormal blood pressure response and marked ischemic ST-segment depression during exercise testing.
- To determine the sensitivity, specificity, and predictive value of these exercise test findings for identifying severe CAD (three-vessel or left main disease).
Main Methods:
- A cohort of 378 consecutive patients underwent maximal symptom-limited exercise testing prior to coronary arteriography.
- Abnormal blood pressure response and marked ischemic ST-segment changes (MIST) were recorded.
- Statistical analysis of sensitivity, specificity, and predictive values for severe CAD was performed.
Main Results:
- An abnormal blood pressure response was observed in 90 patients, with a sensitivity of 38.6% and specificity of 87.4% for severe CAD.
- Marked ischemic ST-segment abnormality (MIST) was present in 85 patients, showing 38.6% sensitivity and 89.8% specificity for severe CAD.
- The combined presence of either abnormal response yielded a sensitivity of 56.4% and specificity of 78.6% for severe CAD.
Conclusions:
- Abnormal blood pressure response and marked ischemic ST-segment depression during exercise testing are useful indicators for identifying patients with advanced coronary artery disease.
- These exercise-induced abnormalities likely stem from exercise-induced myocardial ischemia.
- Exercise testing provides a valuable non-invasive tool for risk stratification in patients with suspected or known CAD.
Abstract:
The usefulness of an abnormal blood pressure response and a marked ischemic ST-segment depression during exercise testing as predictors of severe coronary artery disease was assessed in 378 consecutive patients who had a maximal symptom-limited exercise test before coronary arteriography. An abnormal blood pressure response occurred in 90 patients. The sensitivity of this response for three-vessel or left main disease was 38.6%, the specificity 87.4% and the predictive value 70%. A marked ischemic ST-segment abnormality (MIST) appeared in 85 patients. The sensitivity of MIST for three-vessel or left main disease was 38.6%, the specificity 89.8% and the predictive value 74.1%. One hundred thirty-eight patients had either an abnormal blood pressure response or a marked ST-segment change. The sensitivity of either response for three-vessel or left main disease was 56.4%, the specificity 78.6%, and the predictive value 66.7%. Exercise duration and ejection fraction were not significantly different in patients with normal or abnormal blood pressure. We conclude that abnormal blood pressure and marked ischemic ST-segment depression during exercise testing are helpful in identifying a subset of patients with advanced coronary artery disease. The physiologic mechanism for these responses is probably exercise-induced ischemia.