Turk Kardiyol Dern Ars. Ahead of Print: TKDA-34358 | DOI: 10.5543/tkda.2018.34358
Tools to Improve Diagnostic Accuracy of Exercise Electrocardiograms in Patients with Atypical Angina Pectoris
Demet Özkaramanlı Gür
, Aydın Akyüz, Şeref Alpsoy, Niyazi Güler
Namik Kemal University Faculty Of Medicine, Cardiology Department, Tekirdag, Turkey
INTRODUCTION Although frequently utilized, exercise ECG provides limited diagnostic accuracy in patients with atypical angina pectoris.
AIM The purpose of this study was to determine possible incremental value of pretest probability(PTP) scores and exercise parameters in discriminating coronary artery disease(CAD) and identify cutoff values of PTP.
METHODS In a retrospective cohort of 207 patients with atypical angina (76 women,131 men; mean age 57.6 ± 8.2 years) who underwent coronary angiography(CAG) after a positive exercise ECG; we calculated PTP suggested by CAD consortium 'basic' and 'clinical' models and exercise parameters of blood pressure(BP) and heart rate(HR) such as exercise duration, maximal metabolic equivalents(METs), HR reserve, HR recovery, chronotropic index, BP reserve, BP recovery, ST/HR ratio. Patients were categorized into true positive(TP) or false positive(FP) groups, depending on the presence of obstructive CAD.
RESULTS TP result was associated with older age, male gender, hypertension, diabetes, hyperlipidemia; higher basic and clinical PTP; higher maximal BP, maximal ST deviation, ST/HR but lower maximal METs, chronotropic index and HR recovery. The basic and clinical PTP and chronotropic index could predict TP test result irrespective of gender. Logistic regression analysis revealed that clinical PTP was the only independent predictor of TP results. A cutoff score of 18 for basic and 21 for clinical PTP were determined to discriminate CAD.
CONCLUSION Our study has shown that, among various electrocardiographic and hemodynamic parameters, 'clinical' PTP and the chronotropic index are the most helpful tools in discriminating patients with CAD in patients with atypical angina.
Coronary artery disease, Exercise Electrocardiogram, pretest probability
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Corresponding Author: Demet Özkaramanlı Gür, Türkiye