Association of Coronary Artery Disease with Abnormal Exercise Electrocardiogram Testing in Hypertensive Patients

Fatehi, Saeed; Rafiei Javazm, Amirreza; Kord, Fatemeh; Torkan, Mohammad Hossein; Torkan, Ali; Sabouri, Erfan

doi:10.30477/cjm.2022.309107.1023

Association of Coronary Artery Disease with Abnormal Exercise Electrocardiogram Testing in Hypertensive Patients

Document Type : Original Article

Authors

Saeed Fatehi ¹

Amirreza Rafiei Javazm ²

Fatemeh Kord ³

Mohammad Hossein Torkan ¹

Ali Torkan ¹

Erfan Sabouri ¹

¹ Clinical Research development center, Najafabad branch, Islamic Azad University, Najafabad, Iran

² BSN of Nursing, Faculty of Nursing & Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

³ BSc Midwifery, Islamic Azad University of Shahrbabak Branch, Shahrbabak, Iran

10.30477/cjm.2022.309107.1023

Abstract

Introduction: Coronary artery disease (CAD) is one of the most common causes of death worldwide. Twenty-five percent of people suffering the disease eventually die from sudden death or acute myocardial infarction. This study was established to determine the correlation between CAD and abnormal exercise electrocardiogram (ECG) testing, hypertension, and other associated risk factors. Methods: This cross-sectional study was performed on 384 hypertensive patients referred to Isfahan Shariati Hospital Exercise ECG Testing Center in 2011 and 2012. Patients who had irregularities in exercise ECG tests and also had a history of hypertension were selected. Patients with abnormal angiography findings were considered as patients with CAD. Sensitivity and false Positivity of exercise testing compared to angiography were calculated and the data were analyzed using SPSS software. Results: In this study of 384 hypertensive patients, angiography was suggestive of CAD in 310 patients. Among these patients who underwent exercise testing and angiography in order to diagnose ischemic heart disease or CAD, the most common risk factors were family history (56%), diabetes (54.2%), dyslipidemia (41.7%), smoking (40.9%), obesity (38.3%), alcohol (13%), addiction (13%), and anxiety (10.9%). The sensitivity and specificity of ECG exercise testing compared to angiography were calculated as 79% and 64%. Conclusion: According to the results obtained; a detailed history taking and assessing the known risks can assist clinicians to establish the most proper approach to CAD. Also depending on the assessed risk, patients with CAD can benefit from ECG exercise testing much more than strategies using cardiac computed tomography angiography primarily in order to minimize the costs and radiation exposure.

Keywords

Coronary Artery Disease

Electrocardiogram Exercise Test

Angiography

Babapour B, Khaledi A. Prevalence of Coronary Artery Disease among the Candidate Patients for Cardiac Valve's Surgery in Tehran - Imam Khomeini Hospital (1999-2003). Journal of Ardabil University of Medical Sciences. 2007;7(3):254-8.
Salarifar M, Kazemeini S.M, Haji Zeinali A.M. Prevalence of Coronary Artery Disease and related risk factors in first degree relatives of patients with premature CAD Tehran Heart Center. Tehran University Medical Journal. 2008;65(1):49-54.
Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low-and middle-income countries. Current problems in cardiology. 2010;35(2):72-115.
Akbar-Zadeh F, Hejazi E, Kooshavar H, Pezeshkian M. Prevalence of cardiovascular diseases and cardiac risk factors in northwestern Tabriz. Med J Tabriz Univ Med Sci Health Serv. 2003;59(11).
DeVon HA, Zerwic JJ. Symptoms of acute coronary syndromes: are there gender differences? A review of the literature. Heart & Lung. 2002;31(4):235-45.
Milner KA, Funk M, Arnold A, Vaccarino V. Typical symptoms are predictive of acute coronary syndromes in women. American heart journal. 2002;143(2):283-8.
Fodor JG, Tzerovska R. Coronary heart disease: is gender important? Journal of Men's Health and Gender. 2004;1(1):32-7.
Chou R, Arora B, Dana T, Fu R, Walker M, Humphrey L. Screening asymptomatic adults with resting or exercise electrocardiography: a review of the evidence for the US Preventive Services Task Force. Annals of internal medicine. 2011;155(6):375-85.
Shahverdi E, Khani MA. Cardiology & Cardiovascular Medicine Journal. 2016.
Myers J, Arena R, Franklin B, Pina I, Kraus WE, McInnis K, et al. Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association. Circulation. 2009;119(24):3144-61.
Asadi H, Darvishi N. The study of results of exercise test in the age 40-60 suffering from atypical chest pain referring to Tohid Hospital in Sanandaj in second half of 1377. Scientific Journal of Kurdestan University of medical Sciences. 2000;14(4):37-3.
Tsarpalis K. Coronary Computed Tomographic Angiography and Potential for Overtreatment. JAMA Intern Med. 2018;178(3):435-6.
Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O'Gara P, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Circulation. 2010;122(21):e525-55.
Aghakhani N, Sharif Nia H, Shamabadi G, TaGhipour B, Nikoonejad A. Survey of the relationship between cardiovascular risk factors and results of exercise test on patients referring to a hospital in Urmia in 2009. Community Health Journal. 2017;7(4):54-61.
Reynolds HR, Shaw LJ, Min JK, Spertus JA, Chaitman BR, Berman DS, et al. Association of Sex With Severity of Coronary Artery Disease, Ischemia, and Symptom Burden in Patients With Moderate or Severe Ischemia: Secondary Analysis of the ISCHEMIA Randomized Clinical Trial. JAMA Cardiol. 2020;5(7):773-86.
Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003.
MOHAMMADPOUR TR, BABAEE G, MAHMOUDI M, Memariani A, MOHSENI A. Evaluation of exercise test variables in diagnosis and prediction of the severity of coronary artery disease by fuzzy discriminant analysis. 2002.
Barth S, Marwan M, Hausleiter J, Moshage W, Korosoglou G, Leber A, et al. Coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD): diagnostic impact and clinical consequences in the German Cardiac CT Registry depending on stress test results. Int J Cardiovasc Imaging. 2019;35(4):741-8.
Kozlov SG, Chernova OV, Shitov VN, Matveeva MA, Alekseeva IA, Saidova MA. [The Diagnostic Accuracy of Exercise Treadmill Testing and Stress Echocardiography for the Detection of Obstructive Coronary Artery Disease in Patients Aged ≥ 70 Years]. Kardiologiia. 2019;59(10):23-30.
Löffler AI, Perez MV, Nketiah EO, Bourque JM, Keeley EC. Usefulness of Achieving ≥10 METs With a Negative Stress Electrocardiogram to Screen for High-Risk Obstructive Coronary Artery Disease in Patients Referred for Coronary Angiography After Exercise Stress Testing. Am J Cardiol. 2018;121(3):289-93.
Foy AJ, Dhruva SS, Peterson B, Mandrola JM, Morgan DJ, Redberg RF. Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(11):1623-31.
Min JK, Gilmore A, Jones EC, Berman DS, Stuijfzand WJ, Shaw LJ, et al. Cost-effectiveness of diagnostic evaluation strategies for individuals with stable chest pain syndrome and suspected coronary artery disease. Clin Imaging. 2017;43:97-105.