title: Increased sensitivity of prolonged P-wave during exercise stress test in detection of angiographically documented coronary artery disease.
abstract: BACKGROUND
  A retrospective study was designed to investigate P-wave duration changes in exercise stress test (EST) for the prediction of angiographically documented substantial coronary artery disease (CAD).
  
  
  METHODS
  We analyzed 265 cases of patients, who underwent EST and subsequently coronary angiography. Analysis of P-wave duration was performed in leads II, V5 at rest, and in the recovery period.
  
  
  RESULTS
  The sensitivity and specificity for the isolated ST-segment depression were only 31% and 76%, respectively. The combination of ST-depression with other exercise-induced clinical and electrocardio-graphic abnormalities (chest pain, ventricular arrhythmia, hypotension, left bundle branch block) was characterized by 41% sensitivity and 69% specificity. The combination of abnormal recovery P-wave duration (≥ 120 ms) with ST-depression and other exercise-induced abnormalities had 83% sensitivity but only 20% specificity. Combined analysis of increased delta P-wave duration, ST-depression and other exercise-induced abnormalities had 69% sensitivity and 42% specificity. Sensitivity and specificity of the increase in delta P-wave duration for left CAD was 69% and 47%, respectively, and for 3-vessel CAD 70% and 50%, respectively. The presence of arterial hypertension negatively influenced the prog-nostic value of P-wave changes in the stress test.
  
  
  CONCLUSIONS
  The results of the study show that an addition of P-wave duration changes assessment to ST-depression analysis and other exercise-induced abnormalities increase sensitivity of EST, especially for left CAD and 3-vessel coronary disease. We have also provided evidence for the negative influence of the presence of arterial hypertension on the predictive value of P-wave changes in the stress test. (Cardiol J 2017; 24, 2: 159-166).
authors.affiliation: Medical University of Warsaw. awsol@wum.edu.pl.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Wsol
authors.forename: Wioletta
authors.initials: W
authors.lastname: Wydra
authors.forename: Marek
authors.initials: M
authors.lastname: Chmielewski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Swiatowiec
authors.forename: Marek
authors.initials: M
authors.lastname: Kuch
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: P-wave; coronary angiography; coronary disease; electrocardiography; exercise stress test