SIGNIFICANCE OF CHEST PAIN WITHOUT ST CHANGES DURING EXERCISE TREADMILL TESTING

Authors

  • Ahmad Masood Akbar
  • Shahid Hameed
  • Muhammad Azhar
  • Saqib Shafi Sheikh
  • Abdul Sattar
  • Tahir Naveed

Abstract

Background: Exercise treadmill test is interpreted as positive or negative for ischemia in thepresence or absence of ST depression respectively. This study was conducted to evaluate thediagnostic value of chest pain without ST depression during exercise treadmill test. Methods: Atotal of 180 patients who had abnormal exercise treadmill test result and subsequently underwentcoronary angiography were studied. Patients were categorised as having ST depression and angina(group A), only ST depression (group B) and only angina (group C). Coronary angiograms of allpatients were assessed and compared. Results: Out of 180 patients [159 (88.3%) men and 21(11.7%) women], 84 patients were in Group A, 64 in Group B and 32 in Group C. Characteristicslike age, sex distribution and risk factors were similar in three groups. Significant coronary arterydisease was seen in 77 (91.7%), 40 (62.5%) and in 25 (78.1%) patients in groups A, B and Crespectively (p=0.02). Triple vessel disease was seen in 21 (25%), 11 (17.2%) and 5 (15.6%)patients in groups A, B and C respectively. Significant disease of left anterior descending arterywas seen in 61 (72.6%), 26 (40.6%) and 23 (71.9%) in groups A, B and C respectively (p=0.001).Conclusion: Occurrence of both ST depression and angina during exercise treadmill test hasstrong association with angiographic coronary artery disease whereas occurrence of either of thetwo has similar association with angiographic coronary artery disease with a trend towards moredisease in the latter.Keywords: Exercise treadmill test, Angina, Coronary angiography, Coronary artery disease

References

Nasir K, Redberg RF, Budoff MJ, Hui E, Post WS,

Blumenthal RS. Utility of Stress Testing and Coronary

Calcification Measurement for Detection of Coronary Artery

Disease in Women. Arch Intern Med 2004;164:1610–20.

Imran S, Ali L, Abid AR, Mohyuddin MT, Rehman A. Role

of exercise stress testing in evaluation of patients presenting

with chest pain. J Postgrad Med Inst 2006;20(1):25–9.

Gorodeski EZ. Ezxercise electrocardiographic testing. In:

Griffin PB, Topol EJ, editors. Manual of Cardiovascular

Medicine (3rd Ed.). New Delhi: Wolters Kluwer/Lippincott

Wiliams & Wilkins; 2009.p. 598–617.

Gibbons RJ, Balady GJ, Timothy Bricker J, Chaitman

BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002

guideline update for exercise testing: a report of the

American College of Cardiology/American Heart

Association Task Force on Practice Guidelines (Committee

to Update the 1997 Exercise Testing Guidelines). J Am Coll

Cardiol 2002;40:1531–40.

Lauer MS. What is the best test for a patient with classic

angina? Cleve Clin J Med 2007;74:123–6.

Ashley EA, Myers J, Froelicher V. Exercise testing in

clinical medicine. Lancet 2000;356:1592–7.

Krause RS. Review of cardiac tests. (last updated Nov 25,

. available from http://emedicine.medscape.com/article/

-overview

Faisal AWK, Abid AR, Azhar M. Exercise tolerance test: a

comparison between true positive and false positive results. J

Ayub Med Coll Abbottabad 2008;19(4):71–4.

Chaitman BR. Exercise stress testing. In: Bonow RO, Mann

DL, Zipes DP, eds. In: Braunwald’s heart disease: A

textbook of Cardiovascular Medicine. Philadlphia: Saunders;

p.195–226.

Gabaldo K, Hadzibegović I, Prvulović D, Vujeva B,

Samardzić P, Danić D. Duke Treadmill Score in prioritizing

patients for coronary angiography: retrospective study of a

Croatian regional hospital. Coll Antropol 2008;32:375–80.

Peterson PN, Magid DJ, Ross C, Vujeva B, Samardzić P,

Danić D, et al. Association of exercise capacity on treadmill

with future cardiac events in patients referred for exercise

testing. Arch Intern Med 2008;168:174–9.

Roger VL, Jacobsen SJ, Pellikka PA Miller TD, Bailey KR,

Gersh BJ. Gender differences in use of stress testing and

coronary heart disease mortality: a population-based study in

Olmsted County, Minnesota. J Am Coll Cardiol

;32:345–52.

Daugherty SL, Peterson PN, Magid DJ, Ho PM, Bondy J,

Hokanson JE, et al. The relationship between gender and

clinical management after exercise stress testing. Am Heart J

;156:301–7.

Shaw LJ, Hachamovitch R, Redberg RF. Current evidence on

diagnostic testing in women with suspected coronary artery

disease: choosing the appropriate test. Cardiol Rev

;8:65–74.

Curzen N, Patel D, Clarke D, Wright C, Mulcahy D, Sullivan

A, et al. Women with chest pain: is exercise testing

worthwhile? Heart 1996;76:156–60.

Rosano GMC, Sarrel PM, Poole-Wilson PA. Beneficial

effect of estrogen on exercise-induced myocardial ischaemia

in women with coronary artery disease. Lancet.

;342:133–6.

Marwick TH, Anderson T, Williams MJ, Haluska B, Melin

JA, Pashkow F, et al. Exercise echocardiography is an

J Ayub Med Coll Abbottabad 2010;22(2)

http://www.ayubmed.edu.pk/JAMC/PAST/22-2/Ahmad.pdf 151

accurate and cost-efficient technique for detection of

coronary artery disease in women. J Am Coll Cardiol

;26:335–41.

Southard J, Baker L, Schaefer S. In search of the falsenegative exercise treadmill testing evidence-based use of

exercise echocardiography. Clin Cardiol 2008;31(1):35–40.

D'Antono B, Dupuis G, Fortin C, Arsenault A, Burelle D.

Detection of exercise-induced myocardial ischemia from

symptomatology experienced during testing in men and

women. . Can J Cardiol 2006;22:411–7.

Xuang Z, Xiaoming W, Guizhen Z, Luguang L, Yang G,

Jijun G. An Analysis of Factors Influencing the Diagnostic

Accuracy of Electrocardiogram Stress Testing. J HK Coll

Cardiol 1998;6:84–7.

Sharieff S, Zaman KS. Exercise tolerance test in patients

presenting with chest pain and normal electrocardiogram. J

Coll Physicians Surg Pak 2002;12:348–52.

Laukkanen JA, Mäkikallio TH, Rauramaa R, Kurl S.

Asymptomatic ST-segment depression during exercise

testing and the risk of sudden cardiac death in middle-aged

men: a population-based follow-up study. Eur Heart J

;30:558–65.

Fuster V, O'Rourke RA, Walsh RA, Poole-Wilson P, editors.

Hurst’s The Heart, 12th Edition. New York: Mc Graw-Hill;

Islam ZU, Kango ZA. A case of electric silence (normal

Electrocardiogram, normal Exercise Tolerance Test and

positive Tropinin-T in a patient with tight left circumflex

Coronary artery disease). Professional Med J 2004;11:232–5.

Youn HJ, Park CS, Cho EJ, Jung HO, Jeon HK, Lee JM, et

al. Pattern of exercise-induced ST change is related to

coronary flow reserve in patients with chest pain and normal

coronary angiogram . Int J Cardiol 2005;101:299–304.

Fearon WF, Lee DP, Froelicher VF. The effect of resting ST

segment depression on the diagnostic characteristics of the

exercise treadmill test. J Am Coll Cardiol 2000;35:1206–11.

Lipinski M, Do D, Morise A, Froelicher V. What percent

luminal stenosis should be used to define angiographic

coronary artery disease for noninvasive test evaluation? Ann

Noninvasive Electrocardiol 2002;7(2):98–105

Downloads

Published

2010-06-01

Most read articles by the same author(s)

1 2 3 > >>