Cardiopulmonary exercise testing is more accurate than ECG-stress testing in diagnosing myocardial ischemia in subjects with chest pain
Cardiopulmonary exercise testing is more accurate than ECG-stress testing in diagnosing myocardial ischemia in subjects with chest pain
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DOI：
10.1016/j.ijcard.2014.04.102
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发表时间：
2014-06-15
影响因子：
3.5
通讯作者：
Perna, Gian Piero
中科院分区：
文献类型：
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作者：
Belardinelli, Romualdo;Lacalaprice, Francesca;Perna, Gian Piero
背景：心肺运动负荷试验（CPET）被用来对心力衰竭的严重程度进行分级并评估其预后。然而，CPET是否可以提高标准ECG应激试验诊断胸痛患者阻塞性冠状动脉疾病（O-CAD）的准确性尚不清楚。方法：我们前瞻性研究了1265名连续受试者（55 +/- 8岁，156名女性），这些受试者通过ECG应激试验（ET）评估胸痛。没有人有O-CAD文件。所有患者都在电子制动循环测力仪上进行了增量CPET和心电图记录。结果：1265例患者中CPET阳性73例，CPET阴性1192例。73名CPET阳性患者和71名CPET阴性患者同意接受核SPECT成像和冠状动脉造影。随访48 +/- 7个月。与ET相比，敏感性、特异性、PPV和NPV均显著提高（ET分别为48%、55%、33%、95%；CPET分别为88%、98%、73%、99%，P < 0.001）。VO2峰值达到预测VO2最大值的91%且无VO2相关心肌缺血体征的患者，100%没有O- CAD的证据。32例CPET阳性患者和8例CPET阴性患者发生心脏事件（log rank 18.2, P < 0.0001）。结论：在胸痛患者中，CPET在检测/排除心肌缺血方面表现出比传统ET更好的诊断和预测准确性。应鼓励医生在临床实践中将其作为一线诊断工具。2014爱思唯尔爱尔兰有限公司版权所有。
Background: Cardiopulmonary exercise stress testing (CPET) is used to grade the severity of heart failure and to assess its prognosis. However it is unknown whether CPET may improve diagnostic accuracy of standard ECG stress testing to identify or exclude obstructive coronary artery disease (O-CAD) in patients with chest pain.Methods: We prospectively studied 1265 consecutive subjects (55 +/- 8 years, 156 women) who were evaluated with ECG stress testing (ET) for chest pain. No one had a documented O-CAD. All patients performed an incremental CPET with ECG recordings on an electronically braked cycle ergometer.Results: Of 1265 patients, 73 had a positive CPET and 1192 had a negative CPET. Seventy-three patients with a positive CPET and 71 patients with a negative CPET agreed to undergo nuclear SPECT imaging and coronary angiography. Follow-up lasted 48 +/- 7 months. As compared with ET, sensitivity, specificity, PPV and NPV were all improved significantly (ET: 48%, 55%, 33%, 95%; CPET: 88%, 98%, 73%, 99%, respectively, P b 0.001). Patients with both peak VO2 > 91% of predicted VO2 max and absence of VO2-related signs of myocardial ischemia had no evidence of O- CAD in 100% of cases. Cardiac events occurred in 32 patients with a positive CPET and 8 patients with a negative CPET (log rank 18.2, P < 0.0001).Conclusions: In patients with chest pain, CPET showed a better diagnostic and predictive accuracy than traditional ET to detect/exclude myocardial ischemia. Its use should be encouraged among physicians as a first line diagnostic tool in clinical practice. (C) 2014 Elsevier Ireland Ltd. All rights reserved.