Document Detail

Pattern of exercise-induced ST change is related to coronary flow reserve in patients with chest pain and normal coronary angiogram.
MedLine Citation:
PMID:  15882679     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the usefulness of exercise treadmill test in determining the true microvasculature-induced ischemia, we compared the pattern of ST depression with coronary flow reserve (CFR) using transthoracic Doppler echocardiography (TTE) in patients with chest pain and normal coronary angiogram. DESIGN: Fifty-nine subjects (M/F=21:38, mean age 55+/-9 years) with chest pain and normal coronary angiogram underwent maximal symptom-limited exercise treadmill test (ETT). CFR was estimated with TTE and dipyridamole. Patients with a history of acute myocardial infarction, regional wall motion abnormalities, hypertrophic cardiomyopathy, ejection fraction less than 50%, or primary valvular heart disease were excluded from this study. RESULTS: No ST change was observed in 20 of 59 (34%) patients, up slope depression was observed in 20 (34%), flat depression in 13 (22%), and down slope depression in 6 (10%). Eleven of thirty nine (28%) exercise positive patients had decreased CFR <2.1. CFR was 3.1+/-0.6 in group with no ST change, 3.1+/-0.6 in group with up slope depression, 2.1+/-0.6 in group with flat depression (p<0.05 versus group with no change and group with upslope depression, respectively), and 2.0+/-0.4 in group with down slope depression (p<0.05 versus group with no change and group with up slope depression, respectively). Flat to down slope depression of ST change during ETT had sensitivity of 58% and specificity of 95% for predicting CFR <2.1. CONCLUSION: Flat and down slope depression of ST segment during ETT might increase the sensitivity and specificity to detect the true microvasculature-induced ischemia that is defined as CFR less than 2.1 in patients with chest pain and normal coronary angiogram.
Ho-Joong Youn; Chul-Soo Park; Eun-Joo Cho; Hae-Ok Jung; Hui-Kyung Jeon; Jong-Min Lee; Yong-Seok Oh; Wook-Sung Chung; Jae-Hyung Kim; Kyu-Bo Choi; Soon-Jo Hong
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of cardiology     Volume:  101     ISSN:  0167-5273     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-05-10     Completed Date:  2005-09-13     Revised Date:  2006-07-12    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  299-304     Citation Subset:  IM    
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, #62 Yoido-dong, Youngdungpo-ku, St. Mary's Hospital, Seoul, 150-713, South Korea.
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MeSH Terms
Blood Flow Velocity
Cardiac Output / physiology*
Echocardiography, Doppler
Exercise / physiology*
Exercise Test*
Microvascular Angina / diagnosis*,  physiopathology*,  ultrasonography
Middle Aged
Sensitivity and Specificity

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