The Role of exercise ECG Test in determining the severity of CAD and the Jeopardy of Myocardium
Annals of the College of Medicine, Mosul,
2020, Volume 42, Issue 1, Pages 68-75
Objective: To assess the value of exercise ECG test in evaluating the severity of coronary artery disease and jeopardy of myocardium.
Methods: A prospective study of 75 consecutive patients were all had history of angina, and they underwent both treadmill test (TMT) and coronary angiography in Mosul Center for Cardiology and Cardiac Surgery in the priod from April 2013 to August 2014 .Those with significant angiographic coronary artery stenosis (61 patients) were divided into four groups according to the size of myocardium supplied by and the resulting jeopardized myocardium. This division depends on identity of involved vessel, number of vessels and the site of the lesion on the involved vessel. Also, the result of TMT with ST depression was classed into class A (ST segment depression involving ≥ 5 leads) and class B (ST depression involving < 5 leads). Correlation between the angiographic groups and the results of TMT regarding the number of leads showing ST changes was done.
Results: The study involved 53 (70.5%) male and 22 (29.5%) female patients. The sensitivity and specificity of TMT were 77% and 71.5%, respectively. There were significant difference between class A and class B in patients with group I angiographic changes (which is the most severe angiographic coronary artery lesions and the largest jeopardized myocardium) and in patients w ith group IV (which is the least severe of coronary lesions with the smallest jeopardized myocardium). These differences became more significant after excluding patients with myocardial infarction (MI) and/or patients who develop severe typical angina (STA) at low workload which preclude continuation of test before appearance of the ECG changes of ischemia. Also w hen comparing group I, II or III separately or collectively with group IV we noticed significant differences regarding both class A or class B, especially after excluding patients with MI and/or patients with STA at low workload.
Conclusion: Our data suggest that exercise ECG test can b e useful in determining the severityof coronary artery disease and size of jeopardized myocardium rather than the location of lesion or number of vessels involved.
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