Role of Exercise Treadmill Testing in the Assessment of Coronary Microvascular Disease,JACC: Cardiovascular Imaging

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Role of Exercise Treadmill Testing in the Assessment of Coronary Microvascular Disease
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2021-08-18 , DOI: 10.1016/j.jcmg.2021.07.013
Diana M Lopez ₁ , Sanjay Divakaran ₁ , Ankur Gupta ₂ , Navkaranbir S Bajaj ₂ , Michael T Osborne ₃ , Wunan Zhou ₂ , Jon Hainer ₂ , Courtney F Bibbo ₂ , Hicham Skali ₁ , Sharmila Dorbala ₂ , Viviany R Taqueti ₂ , Ron Blankstein ₁ , Marcelo F Di Carli ₁

Affiliation

Objectives

The authors aimed to study the sensitivity and specificity of exercise treadmill testing (ETT) in the diagnosis of coronary microvascular disease (CMD), as well as the prognostic implications of ETT results in patients with CMD.

Background

ETT is validated to evaluate for flow-limiting coronary artery disease (CAD), however, little is known about its use for evaluating CMD.

Methods

We retrospectively studied 249 consecutive patients between 2006 and 2016 who underwent ETT and positron emission tomography within 12 months. Patients with obstructive CAD or left ventricular systolic dysfunction were excluded. CMD was defined as a coronary flow reserve <2. Patients were followed for the occurrence of a first major adverse event (composite of death or hospitalization for myocardial infarction or heart failure).

Results

The sensitivity and specificity of a positive ETT to detect CMD were 34.7% (95% CI: 25.4%-45.0%) and 64.9% (95% CI: 56.7%-72.5%), respectively. The specificity of a positive ETT to detect CMD increased to 86.8% (95% CI: 80.3%-91.7%) when only classifying studies with ischemic electrocardiogram changes that lasted at least 1 minute into recovery as positive, although at a cost of lower sensitivity (15.3%; 95% CI: 8.8%-24.0%). Over a median follow-up of 6.9 years (IQR: 5.1-8.2 years), 30 (12.1%) patients met the composite endpoint, including 13 (13.3%) with CMD (n = 98). In patients with CMD, ETT result was not associated with the composite endpoint (P = 0.076).

Conclusions

Our data suggest limited sensitivity of ETT to detect CMD. However, a positive ETT with ischemic changes that persist at least 1 minute into recovery in the absence of obstructive CAD should raise suspicion for the presence of CMD given a high specificity. Further study is needed with larger patient sample sizes to assess the association between ETT results and outcomes in patients with CMD.

中文翻译：

跑步机运动测试在评估冠状动脉微血管疾病中的作用

目标

作者旨在研究运动平板测试 (ETT) 在诊断冠状动脉微血管疾病 (CMD) 中的敏感性和特异性，以及 ETT 结果对 CMD 患者的预后影响。

背景

ETT 已被验证可用于评估限流性冠状动脉疾病 (CAD)，但对其用于评估 CMD 的用途知之甚少。

方法

我们回顾性研究了 2006 年至 2016 年期间 12 个月内接受 ETT 和正电子发射断层扫描的 249 名连续患者。患有阻塞性 CAD 或左心室收缩功能障碍的患者被排除在外。 CMD 定义为冠状动脉血流储备<2。对患者进行首次主要不良事件（死亡或因心肌梗塞或心力衰竭住院的复合事件）的发生情况进行随访。

结果

阳性 ETT 检测 CMD 的敏感性和特异性分别为 34.7% (95% CI: 25.4%-45.0%) 和 64.9% (95% CI: 56.7%-72.5%)。当仅将缺血性心电图变化持续至少 1 分钟恢复后的研究分类为阳性时，检测 CMD 的阳性 ETT 特异性增加到 86.8%（95% CI：80.3%-91.7%），尽管代价是灵敏度较低（15.3%；95% CI：8.8%-24.0%）。在中位随访 6.9 年（IQR：5.1-8.2 年）中，30 名患者（12.1%）达到了复合终点，其中 13 名患者（13.3%）患有 CMD（n = 98）。在 CMD 患者中，ETT 结果与复合终点无关(P = 0.076)。