Related Experiment Videos
Different protocols generate variations in systolic blood pressure response after exercise in patients with coronary
M Romano1, S Cardei, I Monteforte
1Cardiopulm Stress Lab, I Clinica Medica, School of Medicine, Università Federico II, Napoli, Italy.
Insights
Analyzing systolic blood pressure (SBP) recovery after exercise can help detect coronary artery disease (CAD). However, inconsistent timing of SBP measurements leads to conflicting diagnostic indications.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Some patients with coronary artery disease (CAD) exhibit abnormal systolic blood pressure (SBP) recovery post-exercise.
- Previous research on SBP recovery's utility in detecting CAD has yielded conflicting results due to varied methodologies.
Purpose of the Study:
- To evaluate the diagnostic performance of different recovery systolic blood pressure (SBP) measurement protocols in identifying coronary artery disease (CAD).
- To assess the impact of SBP recording timing on the accuracy of detecting exercise-induced myocardial ischemia.
Main Methods:
- Sixty-four male patients underwent symptom-limited treadmill stress testing with electrocardiographic and serial blood pressure monitoring.
- Coronary angiography was used to confirm CAD in 43 patients; 21 served as controls.
- Sensitivity, specificity, and classification rates were calculated for ST segment analysis and two recovery SBP ratios (RR/R and RR/P).
Main Results:
- ST segment analysis showed 53% sensitivity and 57% specificity.
- The RR/R SBP ratio yielded 73% sensitivity but only 23% specificity.
- The RR/P SBP ratio demonstrated 53% sensitivity and 71% specificity, with significant variations observed based on SBP measurement timing.
Conclusions:
- Recovery systolic blood pressure (SBP) analysis shows potential for detecting coronary artery disease (CAD), but performance varies significantly with measurement timing.
- The RR/P ratio appears more specific than RR/R, but discrepancies highlight the need for standardized SBP measurement protocols.
- Inconsistent timing of SBP recordings may lead to conflicting clinical interpretations regarding CAD diagnosis.
Abstract:
Some patients with coronary artery disease (CAD) and exercise-induced myocardial ischemia demonstrate no change or a paradoxical increase in systolic blood pressure (SBP) during recovery following exercise. Previous studies have investigated the significance and clinical usefulness of analysis of recovery SBP response in detecting CAD, but conflicting data have been reported. Different protocols were used for the time of SBP recording and either bicycle or treadmill testing. We studied the exercise response in 64 male patients investigated for CAD who underwent symptom-limited treadmill stress testing during electrocardiographic monitoring and serial recording of blood pressure. Forty-three patients showed on or more stenoses of at least 70% at angiography (CAD). Twenty-one patients with normal coronary tree or slight lesions served as controls. The sensitivity (true positive/all CAD patients), specificity (true negative/all CAD-free patients), and the correct classification rate (correct diagnoses/all subjects) were assessed by standard ST segment analysis and two recovery SBP ratios calculated by dividing the first minute recovery SBP by the immediate postexercise value (RR/R) or by the true peak exercise value (RR/P). ST segment analysis achieved 53% sensitivity, 57% specificity, and 54% correct classification, the RR/R ratio achieved 73%,23%, and 60%, and the RR/P ratio 53%, 71%, and 59%, respectively. There were significant differences in results using these ratios. Time of SBP recording generated discrepancies in recovery SBP ratios. Therefore, differences in the timing of SBP measurement may generate conflicting clinical indications.