Inability of the Submaximal Treadmill Stress Test to Predict the Location of Coronary Disease

Abstract

SUMMARYTwo hundred patients had submaximal treadmill stress tests (STSTs) and selective coronary arteriography performed within 2 months of each other. An attempt was made to assess the predictability of disease isolated to any given coronary vessel by performance on the treadmill. This was not possible for disease isolated to the right coronary, the left anterior descending, the circumflex branch of the left coronary, or a combination of right coronary and circumflex arteries. Eleven patients had disease in the left main coronary artery; all had associated disease of some other branch as well. One of these patients had a negative submaximal treadmill stress test but was unable to reach 90% of his maximum predicted heart rate. The remaining 10 patients had positive STSTs. Patients with 26-50% narrowing of any branch had treadmill results similar to those with 51-75% narrowing. There was a large number of patients with single-vessel disease in the study and most of the negative STSTs occurred in this group. Nevertheless, within this group no one vessel gave a higher incidence of positive STSTs than any other. It is concluded that (1) (1) specific branch of the coronary tree involved; (2) severity of luminal narrowing, i.e., the maximal narrowing of any branch of the coronary tree; and (3) extent of vascular involvement, i.e., number of branches narrowed.

Cardiogoniometry: A new noninvasive method for detection of ischemic heart disease

“…The same problems are encountered in stress electrocardiography (Kaplan et a/., 1973;Robertson et al, 1976). However, there was at least a trend noticeable in patients with a single stenosis of the left anterior descending coronary artery or the right coronary artery.…”

Valor diagnóstico do teste ergométrico na detecção da isquemia miocárdica silenciosa no paciente idoso com hipertensão sistólica

“…A incidência de doença triarterial ou de tronco da coronária esquerda nesses estudos, quando a depressão de ST foi >2 ou 3mm alcançou 57%-75% 52,55 . Os resultados de nosso estudo sugerem que, embora a quantidade de depressão de ST e tempo de recuperação podem ter bom valor preditivo para presença de IMS e DAC em hipertensos, não devem ser considerados como fortes preditores para a severidade da DAC obstrutiva quando comparados com estudos de angiografia coronária [28][29][30]40,43 . Outros índices, como carga de trabalho alcançada, tolerância ao esforço, angina intra-esforço, dispnéia excessiva, comportamento da PA intra e pós-esforço e duplo produto são também de grande valor em avaliar a reserva coronária regional e global 39,[44][45][46][47] .…”

“…Assim, este estudo confirma o alto valor preditivo do TE relativo a IMS 36,52,55,57 . A positividade do exame em estudos comparativos com angiografia coronária nem sempre mantém relação com DAC obstrutiva 22,25,29,50 . Em pessoas hipertensas, esta não concordância da positividade do ECG de esforço, ausência de obstrução coronária à angiografia não deveria defini-lo como falso positivo, mas em grande percentagem dos casos, indício de déficit perfusional por doença arteriolar hipertensiva 36,52,53 .…”

The Exercise Electrocardiogram in Diagnosis

“…Newer insights about exercise testing Appropriate separation of uses: diagnosis, function, prognosis Objective confirmation of symptoms Repeatable assessment of therapy effect High yield around target heart rate Linear relation of work load and oxygen requirement Limitations for coronary anatomy diagnosis Probabilistic vs. all-or-none interpretation Relation of STD contour to severity and prognosis Relation of STD work load to severity and prognosis Relation of STD amplitude to severity Relation of STD duration to severity Significance of concordant STD during exercise and recovery Diagnostic use of discrepant pain, work load and STD Contribution of old Ml to false-negatives Prognostic importance STD in post-MI and well groups Equivalent importance of ST elevation Importance of multiple leads to detect Significance of fall in heart rate or pressure Prognostic importance of work capacity and heart rate x pressure Absence of a valid independent diagnostic reference significantly involved on angiography. A very clear tendency is seen for the test to be less than 50% sensitive for 1-vessel disease and generally 90% or better in sensitivity for 3-vessel disease [8,10,13,15].…”