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Exercise electrocardiogram – a diagnostic test of the past?
Session:
Posters (Sessão 1 - Écran 6) - DAC e Cuidados Intensivos 1 - Síndromes Coronários Crónicos
Speaker:
Raquel Menezes Fernandes
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Raquel Menezes Fernandes; Hugo Alex Costa; Miguel Espírito Santo; Dina Bento; João Pedro Guedes; Hugo Vinhas; Ilídio Jesus
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Functional non-invasive tests are useful to detect myocardial ischemia in patients with chronic coronary syndrome (CCS), but exercise electrocardiogram (ECG) has now a secondary role in the diagnosis of obstructive coronary artery disease (CAD).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To characterize CCS patients referred to coronary angiography (CA) after a positive exercise ECG, in whom obstructive CAD is detected.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>We performed a retrospective study enrolling CCS patients referred to CA in our Cardiology Department from October 2018 to January 2021, after a positive ischemia test. We then selected those that only performed an exercise ECG as an initial diagnosis test. Clinical characteristics, complementary diagnostic exams and angiographic characteristics were analysed. Obstructive CAD was defined as the presence of at least one stenosis ≥70% (>50% in the case of the left main coronary artery - LMCA)<strong>.</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> During this period, 236 CCS patients were referred to CA, with a median age of 67 years-old and male predominance (76,6%). The prevalence of cardiovascular risk factors was high (arterial hypertension–76,3%; dyslipidemia–88,1%; diabetes mellitus–36,4%; smoking habits–46,2%; obesity–18,1%). 15,7% of patients had a previous MI, 79,5% were in CCS class II and 84,4% had preserved left ventricle ejection fraction. One hundred and forty-eight patients (62,7%) only performed exercise ECG, with a sensitivity rate of 68,2%, which was higher than myocardial perfusion scintigraphy (54,2%). Patients with obstructive CAD were predominantly male (84,2% vs 59,6%; p=0,001), had a larger frequency of chest pain (89,1% vs 75,6%; p=0,044) and a higher pre-test probability (36,04±13% vs 28,26±13,4%; p=0,012). Patients with a clinical and electrically positive exercise ECG had a larger prevalence of obstructive CAD (61% vs 30,8%; p=0,01), most of them with a shorter duration of exercise (5,92 vs 7,5 min; p=0,095) and ST-segment depression in inferolateral leads (38,5% vs 12,3%; p=0,471). The rate of severe CAD was 48% (LMCA disease – 9,5%, proximal left anterior descendent artery stenosis – 26,4%, multivessel disease – 37,8%) and 21,6% had at least one chronic total occlusion. Coronary intervention was performed in 96% of patients with obstructive CAD. Major complications occurred in 2,1%. After multivariable analysis, only a clinical and electrically positive exercise ECG was an independent predictor of obstructive CAD (p=0,016). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>In our study, 68,2% of CCS patients with a positive exercise ECG had obstructive CAD. Exercise ECG is an easily accessible and low-cost exam. It still has a role in diagnosing CAD, especially in patients with a simultaneous clinical and electrically positive test.</span></span></p>
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