Clinical Usefulness of Exercise-Induced ST-Segment Depression Occurring or Increasing during the Recovery Phase

Norma Crudo, José Castellano, Alfredo Piombro, Jorge Szarfer, Juan Gagliardi, Luis Vidal

Abstract


Background

Despite the current availability of diagnostic image tests with

excellent diagnostic and prognostic accuracy, exercise stress

testing (EST) remains as the procedure most commonly used

for the evaluation, diagnosis and risk stratification of patients

with coronary artery disease (CAD).

Objectives

1) To investigate the clinical usefulness of significant

exercise-induced ST-segment depression (ST-d) occurring or

increasing during the recovery phase of exercise stress test

and to compare it with significant ST-segment depression

presenting during the active phase of exercise; 2) to evaluate

the clinical data and the information provided by EST and

coronary angiography.

Material and Methods

Clinical and EST data from 147 patients with positive stress

test were analyzed. All patients had significant ST-segment

depression and were divided into three groups: GI, 94 patients

with ST-d during exercise; GII, 29 patients with ST-d only during

the recovery phase; and GIII, 24 patients with borderline

ST-d during exercise which became significant during the

recovery phase. The results of the EST were correlated with

the coronary angiography findings in each group.

Results

A diagnosis of significant CAD was made in 78 patients in

GI (82.9%), in 22 in GII (75.8%) and in 21 in GIII (87.5%) 

(p = 0.52). Patients in GIII were older, with high prevalence

of dyslipemia, history of previous infarction and three-vessel

and/or left main coronary artery disease. GII presented the

higher number of asymptomatic patients with one-vessel

disease and high prevalence of CAD.

Conclusions

There were no statistical differences in the percentage of

patients with significant CAD among the groups. Patients

in GIII had high prevalence of significant and severe CAD.

A proper evaluation of ST-d occurring or becoming significant

during the recovery phase provided additional clinical

information to the results of the EST.


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar