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[Relationship between coronary angiographic findings and exercise Ecg in patients without transmural myocardial
Insights
Exercise stress tests accurately detect coronary artery stenosis, especially when combined with angina symptoms. Agreement between exercise tests and coronary angiography is high, particularly in men without digitalis use.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Exercise stress testing is a common diagnostic tool for coronary artery disease.
- Coronary angiography remains the gold standard for assessing coronary artery stenosis.
Purpose of the Study:
- To compare the diagnostic accuracy of supine exercise tests with coronary angiography in patients without transmural myocardial infarction.
- To evaluate the influence of factors like gender, digitalis use, and symptom presentation on test agreement.
Main Methods:
- Retrospective analysis of 311 patients (269 men, 42 women) undergoing both supine exercise tests and coronary angiography.
- Correlation of exercise-induced ST-segment depression and angina pectoris with angiographic findings of >= 50% stenosis.
Main Results:
- Patients with ischemic ST-segment depression and angina had an 86.1% rate of significant coronary stenosis.
- Agreement between exercise tests and angiography was higher in men (91.3%) than women (56.2%) and in non-digitalis users (92.7%).
- High agreement (97.9%) was achieved excluding women, digitalis users, and those with intramural myocardial infarction.
Conclusions:
- Supine exercise testing demonstrates good correlation with coronary angiography for detecting significant coronary artery stenosis.
- Factors such as gender and digitalis use can influence the agreement between these diagnostic modalities.
- The presence and severity of ischemic ST-segment depression and reduced exercise tolerance correlate with the extent of coronary artery disease.
Abstract:
In 311 patients (269 men and 42 woman, 20 to 65 years old) without transmural myocardial infarction the results of exercise tests in supine position were compared with the results of coronary angiography. 1. Patients having ischemic ST-segment depression (greater than or equal to 0.1 mV) and angina pectoris during exercise (n = 108) showed a greater than or equal to 50% stenosis of at least one vessel in 86.1%. In men the number of a greater than or equal to 50% stenosis was significantly higher than in women (91.3 vs. 56.2%). In patients without digitalis agreement with coronary angiographic findings is higher than in patients with digitalis (92.7 vs. 79.2%). After excluding women, patients under digitalis and those with an intramural myocardial infarction, agreement was 96.8%. 2. In patients having ischemic ST-segment depression agreement was 30% and in those with angina pectoris 36.8%. 3. In patients having neither ischemic ST-segment depression nor angina pectoris during exercise up to a heart rate of 80% of the age-dependent heart rate limit a coronary angiogram without a greater than or equal to 50% stenosis was found in 87.6%. After excluding patients with an intramural myocardial infarction, women and patients under digitalis, agreement increased to 97.9%. 4. In patients having both ischemic ST-segment depression and angina pectoris during exercise a 2- or 3-vessel disease was more often found than in patients having either ischemic ST-segment depression or angina pectoris, or in those having neither ischemic ST-segment depression nor angina pectoris respectively (57.5% vs. 16.6, 8.9 and 1.9%). 5. The number of positive coronary angiograms, especially of 2- and 3-vessel disease, increases with the degree of an ischemic ST-segment depression and the reduction of exercise tolerance.