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Exercise testing is sensitive for coronary artery disease when ST-segment changes, angina, and hemodynamic variables are considered - but it's still not as sensitive as computed tomographic angiography (CTA), a study from Denmark shows.

Lead author Dr. Kristian A. Ovrehus, of Lillebaelt Hospital, Vejle, and colleagues compared three approaches: exercise testing and ST-segment changes alone; exercise testing with ST-segment changes, development of angina, and hemodynamic changes; or CTA.

The authors defined an ST-segment change as any horizontal/descending ST depression or elevation >0.1-mV measured more than 80 ms from the J-point. Positive CTAs showed a coronary lumen reduction of at least 50%.

Of the total study cohort of 100 patients (50% men; mean age, 61), 18% had 1-vessel disease, 5% had 2-vessel disease, and 6% had 3-vessel disease.

The researchers report in the American Journal of Cardiology published online February 8th that using ST-segment changes only, exercise testing had a sensitivity of 45% and a specificity of 63%. With all variables included, the sensitivity rose to 72%, and the specificity fell to 37%.

CTA, however, had a sensitivity of 97% and a specificity of 80%.

"Previous reports on the diagnostic performance of exercise testing and coronary CT angiography indicate that these non-invasive diagnostic tests seem to perform differently in different patients cohorts," Dr. Ovrehus told Reuters Health in an email. He noted that more prospective and large-scale trials are needed in order to delineate their relative diagnostic value.

"Our next step research-wise is to look at the clinical consequences of the two non-invasive diagnostic strategies, i.e. their influence on additional downstream testing, cost, as well as on prognosis," Dr. Ovrehus said.
 
Source: ACR

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