The Role of New Two Parameters to Improve Diagnostic Accuracy of Treadmill Exercise Test Detect Significant Coronary Artery Disease

Author : M.A. ffendy, G. R. Endamatriza, B. B. Tiksnadi, M. Akbar, A. Purnomowati, T. A. Aprami
Upload Date : 19-04-2018

Background : The new criteria of positivity of exercise stress testing for diagnostic methods to detect coronary artery disease (CAD) are the ST/HR Hysteresis and ST/HRindex. The study sought to analyze the relation between combining ST/HR Hysteresis and ST/HR index with the presence of significant CAD.

Method: We conducted a single center, retrospective descriptive analytic study in patients with positive ischemic response from exercise stress test, and had both parameters data. All patients should underwent coronary angiography in Hasan Sadikin Hospital within the period December 2015 to August 2017. The value of ST/HR hysteresis and ST/HR index was calculated automatically from stress test machine. Significant CAD was defined based on coronary angiography finding of stenotic lesions ≥ 70% at the major coronary arteries and/or ≥ 50% at the left main coronary artery.

Results: Of 90 enrolled patients meet inclusion criteria, 36 underwent coronary angiography. We identified 22 patients had significant CAD (PPV : 61.1%). The Mann-Whitney test revealed a significant difference ST/HR hysteresis between patients with significant CAD and those without (median 0,075 (0,022 – 0,380) vs 0,032 (0,001 – 0,177)), p-value <0,001) but not significant difference ST/HR index between patients with significant CAD and those without (median 0,91 (0,06 – 4,88) vs 0,71 (0,14 – 2,60)), p-value 0,620). Based on the receiver operating characteristic (ROC) analysis, ST/HR hysteresis >0,045 had area under curve (AUC) of 0,864, resulting in sensitivity of 95,2% and specificity of 71,4% (p <0,001). Combining ST/HR hysteresis and ST/HR index increasing specificity 5,5% (p<0,001). Conclusions: In patients with positive ischemic response in exercise stress test, the value of ST/HR hysteresis is associated with significant CAD but not with ST/HR index. Combining ST/HR hysteresis and ST/HR index could increase specificity to detect significant CAD.

KEYWORDS : Coronary artery disease, Exercise stress test, ST/HR hysteresis, ST/HR index

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