Studies on ergometer exercise testing I. Significance of the type of st‐segment response, sex, and chest pain

Abstract

Summary:Ergometer exercise electrocardiographic (EECG) data were surveyed in a series of 328 patients (277 men and 5 1 women) subjected to coronary arteriography. The sensitivity and specificity of EECG for coronary artery disease (CAD) were 84% and 54%, respectively. The predictive accuracy of a positive test for CAD was 95% in men and 81 % in women. The predictive accuracy of a negative test was 25% in men and 62% in women. When slowly ascending ST depression was considered insignificant, the sensitivity of EECG declined to 71 %, with an increase in specificity to 64%. CAD was present in 89% of the patients with slowly ascending ST depression and 65% of them had a multivessel disease. Seventy-two subjects had postexercise ST-segment elevation. The predictive value of this sign for CAD was 94%. Exercise-induced chest pain had quite a similar diagnostic significance as EECG. The prevalence of CAD in patients with a history of typical angina was 94% in both sexes. Atypical chest pain was associated with normal coronary arteriography in 59% of males and 100% of females.

Studies on ergometer exercise testing II. Effect of previous myocardial infarction, digoxin, and β‐blockade on exercise electrocardiography

“…As we reported previously (Pellinen et al, 1986), postexercise ST evolution took place in 23% of the subjects. Its predictive value was 94% for CAD and 81% for MVD.…”

“…EST protocol and subdivision of ST-segment response to slowly ascending, horizontal, or descending ST depression, ST elevation, and criteria of postexercise ST evolution were described earlier (Pellinen et al, 1986). ST-segment deviation of 0.1 mV or more from the baseline lasting for 80 ms after the J point was considered significant.…”

“…Sensitivity, specificity, and predictive accuracy for positivity and negativity were defined as before (Pellinen et al, 1986).…”

“…In the first part of this study we analyzed the diagnostic significance of the history of chest pain and EST in a random sample of 328 patients referred for the evaluation of CAD (Pellinen et al, 1986). The purpose of this report is to determine the influence of past MI, digitalis, and/or P-blockade on EECG, with a special reference to ST-segment morphology.…”

Coronary Collateral Circulation

“…20,23,35 When the arteriogram is performed two weeks later, collateral vessels are visible in most of the patients, especially in association with total occlusion of the coronary artery.23.35,36 The degree ofcoronary stenosis prior to infarction may predict the visibility of collaterals, since collateral circulation during acute infarction is more frequent in preinfarction angina than in its absence.37 There are also case reports of patients with acute traumatic coronary occlusion with otherwise healthy coronary arteries, in whom collateral vessels to the occluded artery have developed within days. 2,38 In humans, the functional significance of collateral circulation during acute infarction seems obvious on the basis of several observations in which the presence of collaterals is associated with improved left ventricular ejection fraction, a smaller degree of regional contraction abnormalities, a better cardiac index, and a smaller rise of the serum creatine kinase (CK) MB activity.2n,21,23,24,39…”