Predictors for coronary artery disease in patients with paradoxical systolic blood pressure elevation during recovery after graded exercise

Hsu, Jung-Cheng; Chu, Pei-Song; Su, Ta‐Chen; Lin, Lian‐Yu; Chen, Wen-Jone; Hwang, Jing-Shiang; Chen, Ming-Fong; Liau, Chiau‐Suong; Lee, Yuan‐Teh

doi:10.1016/j.ijcard.2006.07.160

Cited by 6 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, abnormal hemodynamic changes after exercise have well established prognostic relevance regarding cardiovascular events and mortality. The delayed decline of SBP during the recovery stage of TET, the so-called paradoxical SBP elevation, was shown to be associated with severe CAD in prior studies [ 23 , 26 , 34 ]. However, like MPI parameters, none of TET parameters rendered acceptable cut-off values.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, previous studies have shown that a number of variables obtained from the treadmill exercise test (TET) alone can be used to estimate prognosis in patients with suspected CAD. ST depression (STD) during the recovery stage [ 20 ], STD corrected by heart rate (HR) [ 21 , 22 ], and post-exercise hemodynamic abnormalities, such as post-stress systolic blood pressure (SBP) [ 23 – 27 ] and HR changes during the recovery stage [ 28 – 31 ], are associated with higher risk of cardiovascular events and mortality.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incremental Diagnostic Performance of Combined Parameters in the Detection of Severe Coronary Artery Disease Using Exercise Gated Myocardial Perfusion Imaging

Liu

et al. 2015

PLoS ONE

View full text Add to dashboard Cite

PurposeMyocardial perfusion imaging (MPI) using gated single-photon emission tomography (gSPECT) may underestimate the severity of coronary artery disease (CAD). This study aimed to evaluate the significance of combined parameters derived from gSPECT, as well as treadmill stress test parameters, in the detection of severe CAD.MethodsA total of 211 consecutive patients referred for exercise MPI between June 2011 and June 2013 (who received invasive coronary angiography within six months after MPI) were retrospectively reviewed. Exercise MPI was performed with Bruce protocol and 201Tl injected at peak exercise. Gated SPECT was performed using a cadmium-zinc-telluride camera and processed by QPS/QGS software. Perfusion defect abnormalities such as sum stress score (SSS); sum difference score, algorithm-derived total perfusion deficits, transient ischemic dilatation ratios of end-diastolic volumes and end-systolic volumes, post-stress changes in ejection fraction, and lung/heart ratio (LHR) were calculated. Treadmill parameters, including ST depression (STD) at the 1st and 3rd minutes of recovery stage (1’STD and 3’STD), maximal STD corrected by heart rate increment (ST/HR), heart rate decline in 1st and 3rd minutes of recovery stage, recovery heart rate ratio (HR ratio), systolic and mean blood pressure ratios (SBP ratio and MAP ratio) during recovery phase were recorded. Diagnostic performances of these parameters were analyzed with receiver operating characteristic (ROC) analysis and logistic regression for detection of left main (≥ 50%) or 3-vessel disease (all ≥ 70% luminal stenosis) on invasive angiography.ResultsAmong various MPI and treadmill parameters used for detection of severe CAD, SSS and ST/HR had the highest AUC (0.78, 0.73, p = NS) and best cut-off values (SSS > 6, ST/HR > 17.39 10-2mV/bpm), respectively. By univariate logistic regression, all parameters except 1’HRR, 3’HRR, SBP and MAP ratios increased the odds ratio of severe CAD. Only increased L/H ratio, 3’STD, and HR ratio remained significant after multivariate regression. The predicted values of combined MPI and treadmill parameters (LHR, 3’STD, and HR ratio) gave the best ROC (AUC: 0.91) than any individual parameter or parameter combination.ConclusionsOf all treadmill and gSPECT parameters, the combination of MPI and treadmill parameters can offer better diagnostic performance for severe CAD.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incremental Diagnostic Performance of Combined Parameters in the Detection of Severe Coronary Artery Disease Using Exercise Gated Myocardial Perfusion Imaging

Liu

et al. 2015

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…22 -25 In some studies, however, the diagnostic value of the SBP ratio and the association between the SBP ratio and cardiac events were attenuated after adjusting for age. 23,24 Compared with the SBP ratio, measurement of abnormal increase in SBP postexercise may be more accurate in identifying CAD because it is a more detailed measure, involving changes in exercise SBP measured electronically at six postexercise time-points rather than just two points while the patient is in the supine position. 7 -16 In addition, measurement of the peak-exercise SBP is required for calculation of the SBP ratio and this is difficult to record in a timely fashion or to measure accurately.…”

Section: Discussionmentioning

confidence: 99%

Using an Abnormal Increase in Postexercise Systolic Blood Pressure to Diagnose Coronary Artery Disease in Gerontal Patients

Yang

Zhu

et al. 2011

J Int Med Res

View full text Add to dashboard Cite

Data from 66 patients ≥ 60 years old with suspected coronary artery disease (CAD) were studied to determine the diagnostic value of an abnormal increase in postexercise systolic blood pressure (SBP) for detecting CAD in gerontal patients. Treadmill exercise testing (TET) and selective coronary angiography (CAG) were carried out and SBP was measured pre-TET and at each minute during a 6-min post-TET recovery phase. Abnormal increase in postexercise SBP was defined as a higher SBP compared with that measured earlier during the 6-min post-TET period. An abnormal increase of ≥ 7 mmHg in postexercise SBP had a statistically significantly better specificity, and also showed higher sensitivity and accuracy, than ST-segment depression ≥ 1 mV in identifying gerontal patients with CAD. The combination of ST-segment depression and abnormal SBP resulted in further improvement of the specificity for detecting CAD. It is concluded that measurement of abnormal increase in postexercise SBP may be a sensitive indicator of gerontal CAD.

show abstract

Usefulness of Paradoxical Systolic Blood Pressure Increase After Exercise as a Predictor of Cardiovascular Mortality

Huang

Chen

et al. 2008

The American Journal of Cardiology

View full text Add to dashboard Cite

Predictors for coronary artery disease in patients with paradoxical systolic blood pressure elevation during recovery after graded exercise

Cited by 6 publications

References 9 publications

Incremental Diagnostic Performance of Combined Parameters in the Detection of Severe Coronary Artery Disease Using Exercise Gated Myocardial Perfusion Imaging

Incremental Diagnostic Performance of Combined Parameters in the Detection of Severe Coronary Artery Disease Using Exercise Gated Myocardial Perfusion Imaging

Using an Abnormal Increase in Postexercise Systolic Blood Pressure to Diagnose Coronary Artery Disease in Gerontal Patients

Usefulness of Paradoxical Systolic Blood Pressure Increase After Exercise as a Predictor of Cardiovascular Mortality

Contact Info

Product

Resources

About