Background
Methods
Study population
Protocol
Exercise electrocardiography
Cardiovascular magnetic resonance
Coronary angiography and analysis by coronary artery territory
Statistical analysis
Results
Study population
Characteristic | Entire Group(n=68) | CAD *(n=20) | No CAD(n=48) | P |
---|---|---|---|---|
Age (yrs) | 66.4±8.8 | 70.8±5.9 | 64.5±9.2 |
0.001
|
CAD risk factors
| ||||
Diabetes | 16 (24%) | 5 (25%) | 11 (23%) | 0.85 |
Hypertension | 45 (66%) | 16 (80%) | 29 (60%) | 0.12 |
Cigarette smoking | 21 (30%) | 5 (25%) | 16 (33%) | 0.50 |
Hyperlipidemia | 41 (60%) | 18 (90%) | 23 (48%) |
0.001
|
Family history of CAD | 33 (49%) | 9 (45%) | 24 (50%) | 0.71 |
Menopause
| 66 (97%) | 20 (100%) | 46 (96%) | 0.35 |
Obesity (BMI ≥ 30 kg/m
2
)
| 19 (28%) | 6 (30%) | 13 (27%) | 0.81 |
Number of risk factors | 3.5±1.4 | 4.0±1.2 | 3.4±1.5 | 0.13 |
Rose chest pain questionnaire
| ||||
Angina | 41 (61%) | 13 (68%) | 28 (58%) | 0.45 |
Medications
| ||||
Statins | 20 (29%) | 8 (40%) | 12 (25%) | 0.22 |
Beta-blockers | 35 (51%) | 14 (70%) | 21 (44%) |
0.05
|
Aspirin | 43 (63%) | 15 (75%) | 28 (58%) | 0.19 |
ACE-inhibitors | 27 (40%) | 8 (40%) | 19 (40%) | 0.97 |
Nitrates | 7 (10%) | 2 (10%) | 5 (10%) | 1.00†† |
Diuretics | 19 (28%) | 3 (15%) | 16 (33%) | 0.12 |
Hormone replacement† | 32 (48%) | 8 (40%) | 24 (52%) | 0.41 |
Blood tests ‡ | ||||
Fasting glucose (mg/dL) | 99.3±16.6 | 101.7±15.6 | 98.4±17.1 | 0.52 |
Lipids | ||||
Total cholesterol (mg/dL) | 225.3±36.8 | 237.6±33.8 | 220.2±37.2 | 0.08 |
LDL (mg/dL) | 137.0±32.5 | 147.3±28.5 | 132.7±33.4 | 0.09 |
HDL (mg/dL) | 59.8±16.8 | 59.9±19.6 | 59.7±15.6 | 0.97 |
Triglycerides (mg/dL) | 146.7±70.0 | 152.3±71.1 | 144.4±70.2 | 0.68 |
hs-CRP (mg/dL) | 0.36±0.5 | 0.48±0.7 | 0.32±0.4 | 0.35 |
Indication for angiography
| ||||
Positive stress nuclear study | 9 (13%) | 5 (25%) | 4 (8%) | |
Positive stress echo study | 6 (9%) | 3 (15%) | 3 (6%) | |
Positive treadmill ECG study | 39 (57%) | 9 (45%) | 30 (63%) | |
Clinical symptoms alone | 14 (21%) | 3 (15%) | 11 (23%) | |
12-lead ECG
| ||||
Q-wave
||
| 5 (7%) | 1 (5%) | 4 (8%) | 1.00†† |
RBBB
#
| 2 (3%) | 1 (5%) | 1 (2%) | 1.00†† |
Exercise ECG
Parameter | Entire Group(n=68) | CAD†(n=20) | No CAD(n=48) | P |
---|---|---|---|---|
Rest HR (beats/min)
| 76.9±13.4 | 72.5±11.9 | 78.7±13.7 | 0.08 |
Rest SBP (mmHg)
| 127.0±20.6 | 128.5±18.6 | 126.4±21.5 | 0.71 |
Rest DBP (mmHg)
| 82.7±11.6 | 85.8±12.9 | 81.3±10.9 | 0.15 |
Peak HR (beats/min)
| 136.7±19.1 | 134.4±18.3 | 137.7±19.5 | 0.52 |
Peak SBP (mmHg)
| 188.0±28.7 | 185.4±16.8 | 189.1±32.6 | 0.54 |
Peak DBP (mmHg)
| 88.9±16.4 | 91.7±13.2 | 87.7±17.6 | 0.37 |
Exercise duration (min)
| 5.4±1.9 | 5.3±1.6 | 5.4±2.1 | 0.76 |
THR reached
| 49 (72%) | 14 (70%) | 35 (73%) | 0.81 |
METs
| 6.0±1.5 | 5.8±1.1 | 6.0±1.7 | 0.62 |
DTS
| −3.0±5.4 | −4.5±5.8 | −2.4±5.1 | 0.12 |
Stress CMR
Parameter | Entire Group (n=68) | CAD† (n=20) | No CAD (n=48) | P |
---|---|---|---|---|
LV Ejection Fraction (%)
| 65.9±10.1 | 63.8±10.1 | 66.8±10.0 | 0.28 |
LV-EDV (ml)
| 95.4±22.8 | 86.7±18.2 | 99.1±23.7 |
0.04
|
LV-ESV (ml)
| 33.4±15.8 | 32.0±13.6 | 34.0±16.7 | 0.64 |
LV-mass (g)
| 103.6±22.5 | 103.5±25.5 | 103.6±21.4 | 0.99 |
LV-EDV Index (ml/m
2
)
| 53.6±12.1 | 50.2±9.5 | 55.0±12.9 | 0.14 |
LV-ESV Index (ml/m
2
)
| 18.8±9.4 | 18.4±7.4 | 19.0±10.2 | 0.83 |
LV-mass Index (gm/m
2
)
| 58.3±12.4 | 60.0±14.4 | 57.5±11.6 | 0.45 |
Comparison between exercise ECG and CMR
CMR Stress Test | ||
---|---|---|
CAD ≥ 70%* | CAD ≥ 50% | |
Sensitivity
| 85% (17/20) | 65% (17/26) |
Specificity
| 94% (45/48) | 93% (39/42) |
Diagnostic Accuracy
| 91% (62/68) | 82% (55/68) |
PPV
| 85% (17/20) | 85% (17/20) |
NPV
| 94% (45/48) | 81% (39/48) |
Exercise ECG | ||
---|---|---|
CAD ≥ 70%* | CAD ≥ 50% | |
Sensitivity
| 50% (10/20) | 50% (13/26) |
Specificity
| 73% (35/48) | 76% (32/42) |
Diagnostic Accuracy
| 66% (45/68) | 66% (45/68) |
PPV
| 44% (10/23) | 57% (13/23) |
NPV
| 78% (35/45) | 71% (32/45) |