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(Circulation. 1996;93:246-252.)
© 1996 American Heart Association, Inc.

Articles

Maximal Blood Lactate Level Acts as a Major Discriminant Variable in Exercise Testing for Coronary Artery Disease Detection in Men

Jean-Claude Barthélémy, MD; Frédéric Roche, MD; Jean-Michel Gaspoz, MD; André Geyssant, MD; Pascal Minini, BS; Anestis Antoniadis, Prof; Éric Page, MD; Jean-Éric Wolf, MD; Claude Wilner, MD; Karl Isaaz, MD; Chantale Cavallaro, MD; Jean-René Lacour, MD

From the Laboratoire de Physiologie-GIP Exercice (J.C.B., F.R., A.G.), Université de Saint-Etienne, France; Département de Médecine Interne (J.M.G.), Hopital Cantonal Universitaire de Genève, Switzerland; Département de Statistiques (P.M., A.A.), Université Joseph Fourier, Grenoble, France; UCPX (E.P.), Grenoble, France; Service de Cardiologie (J.E.W.), Hopital Universitaire de Dijon, France; Clinique du Tonkin (C.W.), Villeurbanne, France; Hopital Universitaire de Service de Cardiologie (I.K.), Saint-Etienne, France; Service de Cardiologie (C.C.), Hopital de Macon, France; and Laboratoire de Physiologie-GIP Exercice (J.R.L.), Université Lyon I, France.

Background The interpretation of exercise stress testing for coronary artery disease detection is affected by the many differences in chosen variables and mathematical methods. We conducted a prospective trial to evaluate a global muscle fatigue parameter—the blood lactate level achieved at maximal exercise—as a method of distinguishing between diseased and nondiseased coronary status.

Methods and Results We evaluated 236 consecutive male patients without previous myocardial infarction who had been referred for the diagnosis of coronary artery disease. None of the patients had cardiomyopathy, severe cardiac heart failure, or valvular heart disease. Blood lactate concentration at maximal exercise was measured as well as other classic variables. Correlations between variables and coronary status as assessed by coronary arteriography were described using receiver operating characteristic (ROC) curves and logistic regression analysis. The first four most powerful variables (lactate level, maximal power output, exercise duration, and percentage of maximal predicted heart rate), which are directly representative of the global functional capacity, showed values of 0.777, 0.775, 0.760, and 0.740, respectively, by ROC curve analysis. Mean±SD blood lactate level at peak exercise reached 7.68±2.70 mmol/L in the 153 diseased and 10.56±2.75 mmol/L in the 83 nondiseased patients (P<.0001). After adjustment for other variables, blood lactate level remained a significant predictor of coronary artery disease by logistic regression analysis (adjusted odds ratio, 1.2; confidence interval, 1.04 to 1.4).

Conclusions Global muscle fatigue as assessed by lactate levels in the blood at maximal exercise appears to be a powerful distinguisher of diseased and nondiseased coronary status.

Key Words: coronary disease • ischemia • diagnosis • tests • exercise

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