02 Nov

New Exercise Parameter for the Identification of Severe Coronary Artery Disease: Conclusion

New Exercise Parameter for the Identification of Severe Coronary Artery Disease: ConclusionThe case we have described here illustrates the clinical usefulness of f SBP-RR in the diagnosis of severe coronary artery disease in patients receiving antianginal therapy. As shown in Figure 2, the patients 12-lead electrocardiographic recordings during peak exercise and recovery period failed to reveal diagnostic ST segment changes, and the patient did not experience exercise-induced angina. However, he had an abnormal SBP-RR which correlated with presence of ischemia on thallium-201 scintigraphy as well as demonstration of three-vessel coronary artery disease on coronary angiography.

The limitation of traditional exercise parameters in the diagnosis of multivessel coronary artery disease in our case is not unique; “equivocal” or “inconclusive” test results occur frequently in patients undergoing exercise treadmill testing. In the study by Iskan-drian and Segal, 71 of 194 patients undergoing selective coronary arteriography and exercise thallium 201 scintigraphy had an inconclusive exercise ECG predominantly due to an achieved peak heart rate of less than 85 percent of the maximum predicted by age and to the presence of baseline ST segment abnormalities. In their study, 26 and 33 of the 71 patients with inconclusive treadmill exercise tests had abnormal thallium 201 scintigrams and significant coronary artery disease (^70 percent luminal narrowing) respectively. The patient in the case reported here only achieved 65 percent of the maximum predicted heart rate and had baseline ST segment abnormalities which failed to reach diagnostic criteria at peak exercise. However, the recovery blood pressure response was abnormal and correlated with angiographic and scintigraphic findings diagnostic of multivessel coronary artery disease. In summary, this case illustrates the importance of the f SBP-RR even in the absence of well accepted hemodynamic and electrocardiographic criteria for the diagnosis of significant multivessel coronary artery disease. This new exercise criterion should improve the diagnostic utility of exercise treadmill testing in patients with limited exercise capacity and baseline electrocardiographic abnormalities.

Categories: Coronary Artery
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