title: Diagnostic usefulness of postexercise systolic blood pressure response for detection of coronary artery disease in patients with echocardiographic left ventricular hypertrophy.
abstract: BACKGROUND
  Although exercise-induced electrocardiographic ST segment changes are used to detect coronary artery disease (CAD), their diagnostic value is markedly decreased in patients with left ventricular (LV) hypertrophy. There have been no reports concerning postexercise systolic blood pressure (SBP) response in patients with ultrasound echocardiographic (UCG) LV hypertrophy and CAD.
  
  
  METHODS
  Sixty-six patients with both UCG-LV hypertrophy (LV mass index 134 g/m2 or greater for men or 110 g/m2 or greater for women) and positive ST depression of at least 0.1 mV during treadmill exercise testing were studied. Coronary cineangiograms showed normal coronary arteries in 19 patients (group 1) and significant CAD in 47 patients (group 2). The SBP ratio was calculated by dividing the SBP 3 min after exercise (3 min SBP) by the SBP at peak exercise (peak SBP).
  
  
  RESULTS
  There were no significant differences between the two groups in LV mass index, SBP at rest, exercise duration, ST depression (at rest and exercise-induced) or 3 min SBP. However, the SBP ratio was significantly higher in group 2 compared with group 1 (0.87+/-0.11 versus 1.01+/-0.18; P=0.004). Analysis of relative cumulative frequency distributions revealed an SBP ratio of 0.92 as the cutoff point for distinguishing a UCG-LV hypertrophy patient with CAD from one without CAD. The sensitivity, specificity and accuracy with an SBP ratio of 0.92 and an ST segment depression of at least 0.1 mV on treadmill exercise testing for detecting CAD in patients with UCG-LV hypertrophy were 77%, 74% and 76%, respectively.
  
  
  CONCLUSIONS
  These findings suggest that the ratio of early post-exercise SBP to peak exercise SBP may be diagnostically useful in detecting CAD in patients with positive ST depression during an exercise test and UCG-LV hypertrophy.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Kiyoyasu
authors.initials: K
authors.lastname: Yamada
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirai
authors.forename: Kazunari
authors.initials: K
authors.lastname: Abe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ishihara
authors.forename: Kyosuke
authors.initials: K
authors.lastname: Takeshita
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Takada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Mutoh
authors.forename: Hironori
authors.initials: H
authors.lastname: Noda
authors.forename: Atsuya
authors.initials: A
authors.lastname: Shimizu
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shibata
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kondo
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Yasuya
authors.initials: Y
authors.lastname: Inden
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology*; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013599:Systole / Q000502:physiology