Assessment of Coronary Artery Disease in Hemodialysis Patients with Delayed Systolic Blood Pressure Response after Exercise Testing

Abstract

Background: We evaluated usefulness of the postexercise systolic blood pressure (SBP) response for detecting coronary artery disease (CAD) in hemodialysis patients. Methods: A treadmill exercise testing was done, and the SBP response was measured in 44 hemodialysis patients (30 men, 14 women; age 41 to 81 years). The postexercise SBP response was defined as the ratio of SBP after 3 minutes of recovery to SBP at peak exercise. Results: The SBP ratio of the 25 subjects with coronary artery stenosis (1.01 ± 0.13) was significantly greater (p <0.01) than 19 subjects without coronary artery stenosis (0.83 ± 0.10). An SBP ratio greater than 0.92 identified CAD with higher sensitivity, specificity, and accuracy than did the conventional ST-segment depression criterion (76 vs. 56%, 90 vs. 53%, and 82 vs. 55%, respectively). Conclusion: Determination of the SBP ratio is a clinically useful, noninvasive method for accurately detecting CAD in hemodialysis patients.

Electrocardiographic exercise stress testing: An update beyond the ST segment

“…Various definitions of abnormal systolic blood pressure recovery exist. For example, a 3 min recovery systolic blood pressure of >90% of peak systolic blood pressure, or a ratio of systolic blood pressure at 3 min recovery to a systolic blood pressure at 1 min recovery > 1 [95]. Abnormal systolic blood pressure recovery is significantly associated with severe CAD (left main, 3 vessel disease, or 2 vessel disease with proximal left anterior descending artery involvement) [96].…”