Author + information
- Mustafa Aparci1,
- Murat Yalcin2,
- Zafer Isilak2,
- Cengiz Ozturk3,
- Omer Uz2,
- Ugur Bozlar4 and
- Ejder Kardesoglu2
Bayes theory propose that predictivity of exercise stress test (EST) increases as the subjects get older and higher risk profile of coronary risk and vice versa. In the era in which coronary imaging was dependent on invasive methods and contrast media revealing negative luminal irregularities and indentation that theory has validity. However extraluminally placed atherosclerotic plaque at initial stage or myocardial bridging which could not produce intraluminal filling defect may be reported as normal coronary artery anatomy in patients with positive or equivocal exercise stress test. Thus positive predictivity of EST was accepted as highly lower in young or young adults with low profile of coronary risk. In this study we aimed to retrospectively evaluate the role of EST in documenting coronary pathology of subjects diagnosed with MSCT angiography.
We retrospectively evaluated the results of EST and presence of coronary artery pathology in 75 patients diagnosed as coronary artery disease by MSCT angiography (320 sliced) from a population of 7500 individuals.
Twelve subjects (16%, age 32.1±9.8) with 9 equivocal and 3 positive EST were diagnosed as normal coronary anatomy by MSCT. Of 63 (%84) patients; 19, 38 and 6 were diagnosed as coronary atherosclerosis (43.3±7.3), myocardial bridging (34.1±8.3) and co-existing coronary atherosclerosis and bridging (45.8±3.8), respectively. Positive predictive value of EST was as 84%.
EST is a valuable method for the evaluation of presence of coronary pathology either atherosclerosis or myocardial bridging in the era of MSCT angiography. So its utility could not be confined to subjects with older ages and high coronary risk profile. It is a convenient method and may effectively indicate the presence of any coronary pathology when used in co-operated with MSCT angiography. It is noteworthy that myocardial bridging is a disease of young and young adults which could potentially underlay the sudden cardiac death or cardiac events among young or middle aged population. Additionally equivocal EST should not be ignored in young subjects with low coronary risk profile especially who may expose to extremely strenuous physical activities due to occupational necessities.