This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wilson, R. F. Articles by White, C. W. Search for Related Content PubMed PubMed Citation Articles by Wilson, R. F. Articles by White, C. W.

Circulation, Vol 83, 412-421, Copyright © 1991 by American Heart Association

ARTICLES

Accuracy of exercise electrocardiography in detecting physiologically significant coronary arterial lesions

RF Wilson, ML Marcus, BV Christensen, C Talman and CW White
Department of Medicine, University of Minnesota, Minneapolis.

The accuracy of exercise electrocardiography in detecting a physiologically significant coronary artery stenosis has been assessed previously by comparing the exercise test with a coronary arteriogram. The inherent inaccuracy of visually determined percent diameter stenosis measurements might have lead to the conclusion that the exercise electrocardiogram was less accurate than it truly was. To determine the accuracy of the exercise electrocardiography in detecting a physiologically significant coronary stenosis, we studied 40 patients with one-vessel, one-lesion coronary artery disease, a normal resting electrocardiogram, and no hypertrophy or prior infarction. Each patient underwent exercise electrocardiography (Bruce protocol) that was interpreted as abnormal if the ST segment developed 0.1-mV or greater depression 80 msec after the J point. The physiological significance of each coronary stenosis was assessed by measuring of coronary flow reserve (peak divided by resting blood flow velocity) in the stenotic artery using a Doppler catheter and intracoronary papaverine (normal, 3.5 or greater peak/resting velocity). The percent diameter and percent area stenosis produced by each lesion were determined using quantitative angiography (Brown/Dodge method). Of the 17 patients with reduced coronary flow reserve (3.5 or greater peak/resting blood flow velocity) in the stenotic artery, 14 had an abnormal exercise electrocardiogram (sensitivity, 0.82; 95% confidence interval, 0.70- 0.94). Conversely, 20 of 23 patients with normal coronary flow reserves had normal exercise tests (specificity, 0.87; 95% confidence interval, 0.77-0.97). The exercise electrocardiogram was abnormal in each of 11 patients with markedly reduced coronary flow reserve (less than 2.5 peak/resting velocity) and in three of six patients with moderately reduced reserve (2.5-3.4 peak/resting velocity). The products of systolic blood pressure and heart rate at peak exercise were significantly correlated with coronary reserve in patients with truly abnormal exercise tests. In comparison, the sensitivity (0.61; 95% confidence interval, 0.46-0.76) and specificity (0.73; 95% confidence interval, 0.60-0.86) of exercise electrocardiography in detecting a 60% or greater diameter stenosis may be significantly lower (p less than 0.05). Exercise electrocardiography, therefore, was a good predictor of the physiological significance (assessed by coronary flow reserve) of a coronary stenosis in patients with a normal resting electrocardiogram and no hypertrophy or prior infarction. Its value in a broader and larger patient population will require further study. These results, however, underscore the importance of a physiological gold standard in assessing the accuracy of noninvasive studies for detecting coronary artery disease.

This article has been cited by other articles:

				K. Kodama-Takahashi, K. Ohshima, K. Yamamoto, T. Iwata, M. Hamada, K. Hiwada, and E. Murakami Occurrence of Transient U-Wave Inversion During Vasospastic Anginal Attack Is Not Related to the Direction of Concurrent ST-Segment Shift* Chest, August 1, 2002; 122(2): 535 - 541. [Abstract] [Full Text] [PDF]

				P. C. Deedwania Silent ischemia predicts poor outcome in high-risk healthy men J. Am. Coll. Cardiol., July 1, 2001; 38(1): 80 - 83. [Full Text] [PDF]

				D. M. Shavelle, M. J. Budoff, D. H. LaMont, R. M. Shavelle, J. M. Kennedy, and B. H. Brundage Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease J. Am. Coll. Cardiol., July 1, 2000; 36(1): 32 - 38. [Abstract] [Full Text] [PDF]

				R. F. Wilson Assessing the Severity of Coronary-Artery Stenoses N. Engl. J. Med., June 27, 1996; 334(26): 1735 - 1737. [Full Text]

				B. De Bruyne, J. Bartunek, S. U. Sys, and G. R. Heyndrickx Relation Between Myocardial Fractional Flow Reserve Calculated From Coronary Pressure Measurements and Exercise-Induced Myocardial Ischemia Circulation, July 1, 1995; 92(1): 39 - 46. [Abstract] [Full Text]