Author + information
A variety of tests are available to establish the diagnosis of coronary heart disease. Coronary angiography is the definitive diagnostic test for the presence of obstructive coronary artery disease. However, it is seldom used as the initial test because of its invasive nature.More practice exercise ECG testing is most useful in patients with an intermediate pretest probability (variably defined as between 25 and 75 percent or between 10 and 90 percent). But diagnosing coronary artery disease is more difficult with exercise ECG test in women with an intermediate pretest probability, because accurancy of exercise ECG is low. So we aimed to increase PPV (positive predictive value) of exercise ECG test together with used troponin T at fourth hour after exercise in women with an intermediate pretest probability.
The study group for the evaluation of the diagnostic value of positive exercise ECG test and troponin T at fourth hour comprised 50 female patients with an intermediate pretest probability. The average age of the patients was 46.08±4.1. All the patients underwent ECG stress test, and all of them also coronary angiography as the next stage of the CAD definitive diagnosis process. During the test their clinical condition, ECG and arterial pressure were monitored. All the patients had positive exercise ECG test results. Additionally, the maximum pulse rate (MPR), number of the achieved metabolic equivalents (MET), stage and reason for termination, if any, were analysed. The degree of coronary stenosis was assessed visually and greater than 50% stenosis of the luminal diameter were considered haemodynamically significant (at any coronary). Troponin T was evaluated in all patient at fourth hour after exercise ECG test. Troponin>0.04 pg/ml was approved positive.
The PPV of only exercise ECG test was 42% in women with an intermediate pretest probability. The PPV of exercise ECG test with troponin T(+) for positive coronary angiography (requirement revascularization at any coronary) was 90%, with troponin T(-) for positive coronary angiography was 30%. If compared, exercise ECG test with troponin T(+) was a better diagnostic predictor of CHD(coronary heart disease) was required revascularization (p<0.001).
Exercise ECG test with troponin T(+) is superior to exercise ECG test with troponin T(-) in the prediction of necessary revascularisation procedures in women with an intermediate pretest probability and positive stress test results.