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Following PTCA exercise tolerance is only moderately correlated with cinevideo-densitometric measurement of
1Department of Cardiology, Middlesex Hospital, London, England, Great Britain.
Insights
Exercise tolerance can indicate restenosis severity after coronary angioplasty. However, this marker is not yet reliable for clinical prediction due to significant variability in patient results.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Restenosis after percutaneous transluminal coronary angioplasty (PTCA) lacks a reliable non-invasive marker.
- Exercise testing variables are underutilized in assessing restenosis severity.
Purpose of the Study:
- To investigate the correlation between exercise test variables and restenosis severity post-PTCA.
- To evaluate the potential of exercise capacity as a non-invasive marker for restenosis.
Main Methods:
- Thirty patients with suspected restenosis underwent symptom-limited exercise testing and coronary angiography.
- Coronary stenosis was quantified using videodensitometry.
- Exercise variables (ST depression, exercise tolerance, rate/pressure product) were correlated with stenosis percentage.
Main Results:
- Maximum exercise tolerance (METs) showed a significant negative correlation with restenosis severity (r=-0.52, p=0.003).
- Maximum exercise duration also correlated negatively with restenosis severity (r=-0.46, p=0.01).
- ST segment depression during exertion did not correlate with restenosis degree.
Conclusions:
- Exercise tolerance is related to restenosis severity in patients post-angioplasty.
- Current exercise test variables demonstrate too much variability to confidently predict restenosis in clinical practice.
Abstract:
There is a pressing need for a non-invasive marker of restenosis following percutaneous transluminal coronary angioplasty. Computerised measurement of restenosis has not been used in conjunction with exercise test variables reflecting maximum exercise capacity. Thus we investigated thirty consecutive patients undergoing repeat coronary angiography for restenosis who had a satisfactory symptom limited exercise test. Exercise test variables namely ST segment depression, maximum exercise tolerance and rate/pressure product were correlated with the percentage stenosis measured by videodensitometry. Maximum exercise tolerance expressed in metabolic equivalents was correlated with restenosis severity (correlation coefficient -0.52, p = 0.003) as was maximum duration of exercise (correlation coefficient -0.46, p = 0.01). Maximum ST segment depression on exertion was not correlated with the degree of restenosis. In assessing patients after angioplasty exercise tolerance is related to the severity of restenosis. However the degree of variation within this relationship is such that it cannot be used confidently in the clinical setting to predict restenosis.