Diagnostic value of combined exercise-induced ST segment changes and heart rate recovery post treadmill exercise for the detection of coronary artery disease in the real world: A single center experience

Abstract

Diagnostic specificity of treadmill exercise test for coronary artery disease (CAD) remains a challenge in daily clinical practice. Present study evaluated the diagnostic value of combining ST segment changes and heart rate recovery (HRR) during/post treadmill exercise test. A total of 105 patients with suspected CAD underwent treadmill exercise test and coronary angiography (CAG) during May 2012 to July 2014. Patients were divided into CAD group (n=48) and non-CAD (N-CAD) group (n=57) according to CAG results. ST segment changes and HRR were analyzed. HRR was significantly lower in CAD group compared non-CAD group (P=0.013) and the prevalence of abnormal HRR (≤24) tended to be higher in CAD group (52.1% vs. 40.3%, p=0.229). Using exercise-induced ST segment changes as CAD diagnosis criteria, the sensitivity was 70.8%, specificity was 52.6%, positive predictive value was 55.7%, and negative predictive value was 68.2%. Combining exercise-induced ST segment changes and abnormal heart rate recovery post treadmill exercise as CAD diagnose criteria, the sensitivity was 41.7%, specificity was 84.2%, positive predictive value was 69.0% and negative predictive value was 63.2%. Combing ST segment changes and HRR can improve the specificity of CAD diagnosis by treadmill exercise test, therefore, this might be a suitable procedure to exclude the CAD diagnosis in patients with suspected CAD.

Keywords: Treadmill exercise test; ST segment changes; Heart rate recovery; Coronary artery disease