Relation between exercise-induced ventricular arrhythmias and myocardial perfusion abnormalities in patients with intermediate pretest probability of coronary artery disease.
The significance of exercise-induced ventricular arrhythmias (VAs) is largely dependent on the clinical characteristics of the studied population. The relation between exercise-induced VAs and myocardial perfusion abnormalities has not yet been evaluated in a homogeneous patient population with intermediate probability of coronary artery disease (CAD). We studied 302 patients (mean age 54+/-9 years, 152 men and 150 women) with intermediate pretest probability of CAD (range=0.25-0.80, mean=0.43+/-0.20) by upright bicycle exercise stress test in conjunction with technetium-99m single-photon emission tomography (SPET) imaging. Exercise-induced VAs (frequent or complex premature ventricular contractions or ventricular tachycardia) occurred in 65 patients (22%). No significant difference was found between patients with and patient without VAs regarding the pretest probability of CAD (0.45+/-0.21 vs 0.43+/-0.20). Patients with exercise-induced VAs had a higher prevalence of perfusion abnormalities (52% vs 26%, P=0.002) and ischaemic electrocardiographic changes (31% vs 16%, P<0.05) compared to patients without VAs. A higher prevalence of perfusion abnormalities in patients with VAs was observed in both men (67% vs 35%, P<0.01) and women (38% vs 16%, P<0.05). However, the positive predictive value of exercise-induced VAs for the presence of myocardial perfusion abnormalities was higher in men than in women (67% vs 38%, P<0.05). The presence of abnormal myocardial perfusion was the only independent predictor of exercise-induced VAs (OR 2.2; 95% CI, 1.2-4.2) by multivariate analysis of clinical and stress test variables. It is concluded that in patients with intermediate pretest probability of CAD, exercise-induced VAs are predictive of a higher prevalence of myocardial perfusion abnormalities in both men and women. However, the positive predictive value of exercise-induced VAs for perfusion abnormalities is higher in men. Because of the underestimation of ischaemia by electrocardiographic changes, exercise-induced VAs should be interpreted as a marker of a higher probability of CAD.
Elhendy
A
A
Thoraxcenter, University Hospital-Dijkzigt, Rotterdam, The Netherlands.
Sozzi
F B
FB
van Domburg
R T
RT
Bax
J J
JJ
Valkema
R
R
Roelandt
J R
JR
D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000209:etiology*; D013667:Technetium; D015899:Tomography, Emission-Computed, Single-Photon; D018879:Ventricular Premature Complexes / Q000209:etiology*
D013667:Technetium