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

ABSTRACT

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 5.31 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: