Discriminant value of ST-segment depression in computerized exercise stress test with different degrees of coronary artery stenosis

Background: Gradual instead of abrupt increases in workload favour a more physiological response in terms of hemodynamic and gas exchange parameters. Therefore, we sought to determine whether myocardial ischemia is attenuated with a ramp compared to a standard Bruce exercise protocol in patients with coronary artery disease (CAD). Methods: We compared ischemic parameters on the Bruce protocol with an individualized ergocycle ramp protocol in 18 men with documented CAD (≥ 70% stenosis) and a reproducible ischemic ECG exercise test. These 2 symptom-limited tests were performed in random order 2 weeks apart. Oxygen consumption (VO2), ischemic threshold [systolic blood pressure x heart rate (RPP) at 1 mm ST-segment depression], and maximum ST-segment depression corresponding to the highest RPP common to the 2 tests (AdjSTmax) were determined. Results: While all subjects showed ischemia on the treadmill, 6/18 did not on the ergocycle. However, ischemic threshold was higher on the ramp than the Bruce protocol (23 420 ± 5 732 vs 20 018 ± 3 542 bpm•min-1•mmHg; P=0.007). Peak RPP was higher during the ramp than with the Bruce protocol (28 492 ± 6 450 vs 25 519 ± 6 067 bpm•min-1•mmHg, respectively; P=0.02), despite similar peak VO2 (25.59 ± 5.05 vs 26.39 ± 4.65 mlO2•kg-1•min-1, respectively; P=0.6). AdjSTmax was less on the ramp than the Bruce protocol (-1.2 ± 0.9 vs -1.9 ± 0.7 mm; P=0.003). Conclusion: Exercise-induced myocardial ischemia is markedly attenuated on the more gradually increasing workload of the individualized ramp ergocycle compared with the standard Bruce treadmill protocol. This effect is unexplained by energy expenditure (VO2) or myocardial work (RPP) and is consistent with a “warm-up” ischemic mechanism. The more gradually increasing workload of the ramp ergocycle protocol may have favoured a “warm-up” ischemic effect despite achieving higher RPP than the Bruce protocol treadmill suggesting it may be physiologically preferable for exercise prescription in patients with CAD.

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Heart rate variability and turbulence to determine true coronary artery disease in patients with ST segment depression without angina during exercise stress testing

Clinical & Investigative Medicine ◽

10.25011/cim.v34i6.15895 ◽

2011 ◽

Vol 34 (6) ◽

pp. 349 ◽

Cited By ~ 1

Author(s):

Atac Celik ◽

Ahmet Ozturk ◽

Kerem Ozbek ◽

Hasan Kadi ◽

Fatih Koc ◽

...

Keyword(s):

Coronary Artery Disease ◽

Heart Rate ◽

Coronary Artery ◽

Stress Test ◽

Exercise Stress Test ◽

Exercise Stress ◽

Diabetic Patients ◽

St Segment ◽

Group 3 ◽

Artery Disease

Purpose: ST segment depression without angina during an exercise stress test causes diagnostic problems, particularly in non-diabetic patients. Heart rate variability (HRV) and heart rate turbulence (HRT) are used to evaluate the changes in cardiac autonomic functions and are also both decreased in patients with coronary artery disease. The aim of this study was determine the values of HRV and HRT that discriminate true coronary artery disease from false positive stress test results. Methods: Ninety non-diabetic patients who underwent diagnostic coronary angiography (CA) due to suspected coronary artery disease after ST segment depression without angina during an exercise stress test were enrolled in the study. Prior to CA, 24 hour ambulatory electrocardiogram recordings were taken and HRV and HRT parameters were calculated. Results: Patients were divided into three groups according to the severity of their coronary lesions: (group 1 normal, group 2 non-obstructive and group 3 obstructive. There were no differences among the groups with regards to age, sex, medical history, medications, systolic and diastolic blood pressures, body mass index, fasting glucose, anemia and thyroid status, lipid profile and creatinine clearance. HRV parameters and turbulence slope (TS) were significantly lower while turbulence onset (TO) was significantly higher in group 3 than groups 1 and 2. According to the cut-off values calculated using ROC analysis, SDNN≤69.63 msec, TO > 0.14%, and TS≤2.78 msec/RR have high diagnostic accuracy for predicting obstructive coronary artery disease. Conclusion: HRV and HRT parameters may provide additional information for discriminating between patients who do and do not truly need CA.

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Cardiovascular risk profiles and stress echocardiography results in patients with hypertensive response to exercise

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4183 ◽

2021 ◽

Vol 26 (5) ◽

pp. 4183

Author(s):

E. A. Karev ◽

E. G. Malev ◽

A. Yu. Suvorov ◽

S. L. Verbilo ◽

M. N. Prokudina

Keyword(s):

Cardiovascular Risk ◽

Coronary Artery ◽

Stress Echocardiography ◽

Coronary Artery Stenosis ◽

Left Ventricular ◽

Artery Stenosis ◽

Exercise Stress ◽

Volume Index ◽

High Cardiovascular Risk ◽

Response To Exercise

Aim. To compare markers of high cardiovascular risk and stress echocardiography results depending on the type of blood pressure (BP) response to exercise in patients without obstructive coronary artery disease.Material and methods. Our single-center cross-sectional study included 96 patients without hemodynamically significant coronary artery stenosis according to coronary angiography or multislice computed tomography angiography. All patients underwent physical examination, cardiovascular risk stratification, electrocardiography, extracranial cerebrovascular ultrasound, echocardiography, treadmill exercise stress echocardiography.Results. According to the test results, the patients were divided into groups with a hypertensive response (n=41) and a normal response to exercise (n=55). Patients with hypertensive response to exercise had significantly higher values of left ventricular mass index (100,0 (90,0; 107,0) g/m2 vs 76,0 (68,0; 91,0) g/m2, p<0,0000001) and left atrial volume index (36,7 (32,0; 46,0) ml/m2 vs 29,7 (26,3; 32,0) ml/m2, p=0,000003). There was also a higher level of cardiovascular SCORE risk (5,0 (2,0; 6,0) vs 2,0 (1,0; 3,0), p=0,004); patients more often had associated clinical conditions (36,6% vs 12,7%, χ2=7,57, p=0,006) and left ventricular diastolic dysfunction (39,02% vs 78,18%, χ2=15,21, p=0,0001). Pathological BP increase during stress echocardiography was associated with worse exercise tolerance (7,4 (5,6; 10,0) METs vs 10,2 (8,4; 11,95) METs, p=0,000041) and more frequent transient regional contractility impairment (46,34% vs 1,8%, p<0,00001), mainly of the lateral and inferior left ventricular walls.Conclusion. Despite the absence of coronary artery stenosis, patients with hypertensive response to exercise are significantly more likely to have markers of high cardiovascular risk and require more careful monitoring of risk factors. Also, the hypertensive response to exercise is associated with more frequent regional contractility impairment even without coronary artery stenosis.

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A false-positive ST segment elevation during exercise stress test

BMJ Case Reports ◽

10.1136/bcr-2013-009199 ◽

2013 ◽

Vol 2013 (apr16 1) ◽

pp. bcr2013009199-bcr2013009199

Author(s):

S. K. Srinivas ◽

I. S. Hirapur ◽

S. Bhairappa ◽

C. N. Manjunath

Keyword(s):

False Positive ◽

Stress Test ◽

Exercise Stress Test ◽

Exercise Stress ◽

St Segment Elevation ◽

St Segment

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Predictors of significant left main/ostial left anterior descending coronary artery stenosis in patients with exercise induced ST segment elevation in lead aVR

European Heart Journal ◽

10.1093/eurheartj/eht308.p2062 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P2062-P2062

Author(s):

M. T. Petrovic ◽

V. Giga ◽

M. Dobric ◽

V. Kovacevic ◽

M. Marinkovic ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Left Main ◽

St Segment Elevation ◽

St Segment ◽

Lead Avr ◽

Exercise Induced

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Application of a novel ultrasound transducer for continuous monitoring treadmill exercise stress echocardiography: Utility in the detection of coronary artery stenosis

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(03)81304-9 ◽

2003 ◽

Vol 41 (6) ◽

pp. 434

Author(s):

Kenichi Nakashiki ◽

Akira Kisanuki ◽

Yutaka Otsuji ◽

Keiko Yuge ◽

Toshinori Yuasa ◽

...

Keyword(s):

Coronary Artery ◽

Stress Echocardiography ◽

Continuous Monitoring ◽

Treadmill Exercise ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Exercise Stress ◽

Ultrasound Transducer ◽

Exercise Stress Echocardiography

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Hemodynamic Characteristics of Patients with Coronary Artery Disease Presenting False-Negative Exercise Stress Test

Angiology ◽

10.1177/000331979204300609 ◽

1992 ◽

Vol 43 (6) ◽

pp. 506-511 ◽

Cited By ~ 1

Author(s):

Michihito Sekiya ◽

Makoto Suzuki ◽

Yasushi Fujiwara ◽

Takumi Sumimoto ◽

Mareomi Hamada ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Test ◽

False Negative ◽

Exercise Stress Test ◽

Exercise Stress ◽

Hemodynamic Characteristics ◽

Artery Disease

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Recent advances in the role of the adenosinergic system in coronary artery disease

Cardiovascular Research ◽

10.1093/cvr/cvaa275 ◽

2020 ◽

Cited By ~ 1

Author(s):

Franck Paganelli ◽

Marine Gaudry ◽

Jean Ruf ◽

Régis Guieu

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Test ◽

Exercise Stress Test ◽

Tissue Hypoxia ◽

Exercise Stress ◽

Fractional Flow ◽

Coronary Syndrome ◽

Flow Reserve ◽

Artery Disease

Abstract Adenosine is an endogenous nucleoside that plays a major role in the physiology and physiopathology of the coronary artery system, mainly by activating its A2A receptors (A2AR). Adenosine is released by myocardial, endothelial, and immune cells during hypoxia, ischaemia, or inflammation, each condition being present in coronary artery disease (CAD). While activation of A2AR improves coronary blood circulation and leads to anti-inflammatory effects, down-regulation of A2AR has many deleterious effects during CAD. A decrease in the level and/or activity of A2AR leads to: (i) lack of vasodilation, which decreases blood flow, leading to a decrease in myocardial oxygenation and tissue hypoxia; (ii) an increase in the immune response, favouring inflammation; and (iii) platelet aggregation, which therefore participates, in part, in the formation of a fibrin-platelet thrombus after the rupture or erosion of the plaque, leading to the occurrence of acute coronary syndrome. Inflammation contributes to the development of atherosclerosis, leading to myocardial ischaemia, which in turn leads to tissue hypoxia. Therefore, a vicious circle is created that maintains and aggravates CAD. In some cases, studying the adenosinergic profile can help assess the severity of CAD. In fact, inducible ischaemia in CAD patients, as assessed by exercise stress test or fractional flow reserve, is associated with the presence of a reserve of A2AR called spare receptors. The purpose of this review is to present emerging experimental evidence supporting the existence of this adaptive adenosinergic response to ischaemia or inflammation in CAD. We believe that we have achieved a breakthrough in the understanding and modelling of spare A2AR, based upon a new concept allowing for a new and non-invasive CAD management.

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