Can presence of multivessel disease be predicted on exercise tolerance test on the basis of exercise capacity

Despite the wide variability of sensitivity and specificity of exercise tolerance test [ETT], it still a useful tool for the evaluation of chest pain because of its simplicity and cost-effectiveness. However, data regarding prediction of severity of disease on the basis of ETT is limited. Therefore, we conducted a study to evaluate that whether we can predict the presence of multi-vessel coronary artery disease [CAD] on the basis of exercise capacity as judged by exercise tolerance test so that such patients can be offered early invasive studies. The mean age was 49.7 +/- 10.7 years, male to female ratio was 5.3:1 Abnormal ETT was found in 70 patients [58.3%] while 50 [41.7%] had normal ETT results. Angiographic evidence of normal coronaries was found in 20.8%, while single vessel CAD was found in 25.8% and multi-vessel CAD in 53.3%. The sensitivity, specificity and test accuracy of ETT in our study was 64.6%, 66.7% and 65%, respectively. Among abnormal ETT results, majority of those who exercised < 8.0 METS were found to have multi-vessel CAD on coronary angiogram vs those who were able to exercise for > 8, 0 METS p-value <0.02]. Thus, low exercise capacity in the presence of abnormal ETT response can predict the multi-vessel CAD. In conclusion, patients with poor exercise capacity of less than 8.0 METS should be subjected to early invasive approach. However, large-scale studies are needed to prove this hypothesis

Sensitivity and specificity of exercise tolerance test in patients with chest pain and normal baseline electrocardiogram

Inspite of wide variability of sensitivity and specificity of exercise tolerance test [ETT], this test still is useful for the evaluation of chest pain because of its simplicity and cost-effectiveness. Therefore, we conducted a study to evaluate the sensitivity and specificity of ETT in our population as wells as to risk stratify these patients. A total of 120 patients were included in this study. The mean age was 49.7 +/- 10.7 years, male to female ratio was 5.3: 1.0. Abnormal exercise tolerance test [ETT] was found in 70 patients [58.3%] while 50 [41.7%] had normal ETT results. Angiographic evidence of normal coronaries was found in 20.8%, while single vessel coronary artery disease [CAD] was found in 25.8% and multi-vessel CAD in 53.3%. The sensitivity, specificity and test accuracy of ETT in our study was 64.6%, 66.7% and 65%, respectively. Age > 50 years, hypertension, diabetes mellitus, hypercholestrolemia and family history of premature ischemic heart disease [IHD] were the significant risk factors for the development of CAD [p-values = 0.001, 0.011, 0.021, 0.011 and 0.001, respectively]