Cardiopulmonary exercise testing is more accurate than ECG-stress testing in diagnosing myocardial ischemia in subjects with chest pain

• Published in: International journal of cardiology Vol. 174; no. 2; pp. 337 - 342
• Main Authors: Belardinelli, Romualdo, Lacalaprice, Francesca, Tiano, Luca, Muçai, Andi, Perna, Gian Piero
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 15.06.2014; Elsevier
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Cardiopulmonary exercise stress testing; Cardiovascular; Chest pain; Chest Pain - etiology; Coronary heart disease; Electrocardiography; Exercise Test; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - diagnosis; Myocarditis. Cardiomyopathies; Obstructive coronary artery disease; Prospective Studies; Reproducibility of Results; Cardiopulmonary exercise stress testing; Obstructive coronary artery disease; Chest pain; Physical exercise; Human; Cardiopulmonary; Myocardial ischemia; Cardiovascular disease; Thorax; Medical screening; Myocardial disease; Coronary heart disease; Obstruction; Stress; Vascular disease; Electrodiagnosis; Pain; Electrocardiography; Exercise tolerance test; Diagnosis; Cardiology
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2014.04.102

Cardiopulmonary exercise stress testing (CPET) is used to grade the severity of heart failure and to assess its prognosis. However it is unknown whether CPET may improve diagnostic accuracy of standard ECG stress testing to identify or exclude obstructive coronary artery disease (O-CAD) in patients with chest pain. We prospectively studied 1265 consecutive subjects (55±8years, 156 women) who were evaluated with ECG stress testing (ET) for chest pain. No one had a documented O-CAD. All patients performed an incremental CPET with ECG recordings on an electronically braked cycle ergometer. Of 1265 patients, 73 had a positive CPET and 1192 had a negative CPET. Seventy-three patients with a positive CPET and 71 patients with a negative CPET agreed to undergo nuclear SPECT imaging and coronary angiography. Follow-up lasted 48±7months. As compared with ET, sensitivity, specificity, PPV and NPV were all improved significantly (ET: 48%, 55%, 33%, 95%; CPET: 88%, 98%, 73%, 99%, respectively, P<0.001). Patients with both peak VO2>91% of predicted VO2 max and absence of VO2-related signs of myocardial ischemia had no evidence of O-CAD in 100% of cases. Cardiac events occurred in 32 patients with a positive CPET and 8 patients with a negative CPET (log rank 18.2, P<0.0001). In patients with chest pain, CPET showed a better diagnostic and predictive accuracy than traditional ET to detect/exclude myocardial ischemia. Its use should be encouraged among physicians as a first line diagnostic tool in clinical practice.