Role of Exercise Treadmill Testing in the Assessment of Coronary Microvascular Disease

JACC-CARDIOVASCULAR IMAGING

卷:15

Article

Lopez, Diana M.^1,2,3  Divakaran, Sanjay^1,2,3  Gupta, Ankur^1,2  Bajaj, Navkaranbir S.^1,2  Osborne, Michael T.^4,5  Zhou, Wunan^1,2  Hainer, Jon^1,2  Bibbo, Courtney F.^1,2  Skali, Hicham^1,2,3  Dorbala, Sharmila^1,2  Taqueti, Viviany R.^1,2  Blankstein, Ron^1,2,3  Di Carli, Marcelo F.^1,2,3 

[1] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Cardiovasc Imaging Program, Boston, MA 02115 USA

[2] Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Cardiovasc Imaging Program, Boston, MA 02115 USA

[3] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Cardiovasc Div, Boston, MA 02115 USA

[4] Harvard Med Sch, Brigham & Womens Hosp, Cardiovasc Imaging Res Ctr, Dept Med, Boston, MA 02115 USA

[5] Harvard Med Sch, Brigham & Womens Hosp, Cardiovasc Imaging Res Ctr, Dept Radiol, Boston, MA 02115 USA

关键词: coronary microvascular disease;    exercise stress testing;    coronary flow reserve;   

DOI  :  10.1016/j.jcmg.2021.07.013

来源: Elsevier

【 摘 要 】

OBJECTIVES The authors aimed to study the sensitivity and specificity of exercise treadmill testing (ETT) in the diagnosis of coronary microvascular disease (CMD), as well as the prognostic implications of ETT results in patients with CMD. BACKGROUND ETT is validated to evaluate for flow-limiting coronary artery disease (CAD), however, little is known about its use for evaluating CMD. METHODS We retrospectively studied 249 consecutive patients between 2006 and 2016 who underwent ETT and positron emission tomography within 12 months. Patients with obstructive CAD or left ventricular systolic dysfunction were excluded. CMD was defined as a coronary flow reserve <2. Patients were followed for the occurrence of a first major adverse event (composite of death or hospitalization for myocardial infarction or heart failure). RESULTS The sensitivity and specificity of a positive ETT to detect CMD were 34.7% (95% CI: 25.4%-45.0%) and 64.9% (95% CI: 56.7%-72.5%), respectively. The specificity of a positive ETT to detect CMD increased to 86.8% (95% CI: 80.3%-91.7%) when only classifying studies with ischemic electrocardiogram changes that lasted at least 1 minute into recovery as positive, although at a cost of lower sensitivity (15.3%; 95% CI: 8.8%-24.0%). Over a median follow-up of 6.9 years (IQR: 5.1-8.2 years), 30 (12.1%) patients met the composite endpoint, including 13 (13.3%) with CMD (n = 98). In patients with CMD, ETT result was not associated with the composite endpoint (P = 0.076). CONCLUSIONS Our data suggest limited sensitivity of ETT to detect CMD. However, a positive ETT with ischemic changes that persist at least 1 minute into recovery in the absence of obstructive CAD should raise suspicion for the presence of CMD given a high specificity. Further study is needed with larger patient sample sizes to assess the association between ETT results and outcomes in patients with CMD. (C) 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

Free