[Discrimination attempt between stenoses of the left trunk and tritroncular involvement using univariate and multivariate analysis of the variables of the exercise test].
One hundred and fifty patients with more than 70 p. 100 three vessel (3V) stenosis and 69 patients with more than 50 p. 100 left main (LM) coronary artery stenosis underwent an exercise test at maximum or symptom-limited level, after discontinuing all anti-ischaemic therapies. Three comparative statistical methods were used: 1. Univariate analysis. Among the mean values of the 17 variables studied, 6 differed significantly (p less than 0.05), viz.: cardiac work performed until the appearance, on the CM5 lead, of an ST depression (STd) of 1 mm (W1) (LM = 1,002 Kpm; 3V = 1,461 Kpm) and of 2 mm (W2) (LM = 2,445 Kpm; 3V = 2,904 Kpm); maximum STd/maximum heart rate ratio; rise of systolic pressure during exercise and rise of heart rate associated with a 2 mm STd less pronounced with LM; maximum exercise capacity (W3) (LM = 2,445 +/- 1,514; 3V = 2,904 +/- 2,095 Kpm). 2. Linear discriminant function analysis. No discriminant variable could be obtained (subjects well classified 53 p. 100, ill-classified 47 p. 100). 3. Multivariate analysis, Cox's model. This method demonstrated that stenosis of the LM coronary artery is characterized by the early appearance of ischaemia rather than by its severity. After 4 minutes of exercise, 62 p. 100 of LM patients and only 28 p. 100 of 3V patients had a 1 mm ST depression. It is concluded that exercise tests do not provide a certainty of LM stenosis, but they identify patients with severe ischemia who most probably have this type of stenosis. Such patients can then be selected for coronary arteriography and operated upon as soon as possible.
Crosnier
F
F
Département des épreuves d'effort et de la réadaptation, hôpital cardiologique du Haut-Lévêque, Pessac.
Moïse
A
A
Douard
H
H
Mora
B
B
Broustet
J P
JP
D000368:Aged; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003937:Diagnosis, Differential; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012044:Regression Analysis; D012189:Retrospective Studies; D013223:Statistics as Topic
Tentative de distinction entre les sténoses du tronc gauche et les atteintes tritronculaires par l'analyse univariée et multivariée des variables de l'épreuve d'effort.