29 Oct

New Exercise Parameter for the Identification of Severe Coronary Artery Disease

New Exercise Parameter for the Identification of Severe Coronary Artery DiseaseExercise testing remains one of the most useful  noninvasive diagnostic tests for identification of the patient with coronary artery disease. Significant ST segment depression, chronotropic incompetence, hypotensive systolic blood pressure response, and angina at low workload have all been shown to be of diagnostic and prognostic value in patients with severe coronary artery disease. However, the sensitivity of these criteria varies considerably, and their diagnostic value can be further limited in the presence of LVH, electrocardiographic conduction abnormalities such as LBBB, arrhythmia such as atrial fibrillation, and in patients receiving medical therapy such as digitalis or beta adrenergic blockers. further

Thus, limitations of exercise ECGs in identifying patients with severe coronary artery disease has prompted research into newer and more sensitive criteria such as the ST/heart rate ratio and evaluation of the systolic blood pressure response during the recovery period.
Recently, the systolic blood pressure recovery ratio (SBP-RR), the ratio of the postexercise systolic blood pressure to peak exercise systolic blood pressure, has been shown to be of diagnostic value in patients with coronary artery disease. We have observed that a SBP-RR which is >1.0, 0.9, or 0.8 at respectively 1, 2, or 3 minutes in the recovery period and further increases from either minutes 1 to 2 or 2 to 3 of the recovery period (f SBP-RR) is highly predictive and more sensitive than diagnostic ST segment depression or angina in the diagnosis of multivessel coronary artery disease. In this case report, we describe the usefulness of an f SBP-RR in the identification of a patient with angiographically proven three-vessel coronary artery disease undergoing exercise thallium 201 scintigraphy.

Categories: Coronary Artery
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