[Treadmill exercise test in patients with hypertrophic cardiomyopathy with and without coronary artery disease].
We studied whether the treadmill exercise test can discriminate between normal and significant narrowing of coronary arteries in patients with hypertrophic cardiomyopathy (HCM) accompanied with chest pain, and we compared the extent of myocardial ischemia during exercise. Thirty one patients with HCM were divided into two groups; 21 with normal coronary arteries and 11 with significant narrowing of coronary arteries. The treadmill exercise test was carried out in both groups. The following parameters were more frequently seen in the group with coronary stenosis. (1) short treadmill time (338, sec vs 542, p less than 0.05). (2) delta SBP less than or equal to 60 mmHg (delta: end point minus rest, 10 cases vs 12, 0.05 less than p less than 0.1). (3) significant delta ST depression (0.17 mV vs 0.05, p less than 0.05). (4) large delta ST/delta HR (3.3 microV.min/beats vs 0.7). delta ST/delta HR greater than or equal to 2.0 was the most useful for differentiating the two groups, and it was 90% in index both sensitivity and specificity for diagnosis of HCM with significant narrowing of the coronary arteries. It was concluded that treadmill exercise induced more severe myocardial ischemia in patients with HCM who had significant narrowing of the coronary arteries than in patients with HCM who had angiographically normal coronary arteries. The delta ST/delta HR was the most useful index for diagnosis of HCM with significant narrowing of the coronary arteries.
Department of Medicine, Kawasaki Medical School.
T
T
Yada
S
S
Nezuo
T
T
Sawayama
K
K
Hasegawa
S
S
Tadaoka
T
T
Nakamura
S
S
Inoue
Y
Y
Kawahara
A
A
Kimura
D001794:Blood Pressure; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005080:Exercise Test; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D013599:Systole