Faisal Abdul Wajid Khan, Abid Abdul Rehman, Azhar Muhammad
Punjab Institute of Cardiology, Lahore, Pakistan.
J Ayub Med Coll Abbottabad. 2007 Oct-Dec;19(4):71-4.
To study the factors which predetermine the coronary artery disease in patients having positive Exercise Tolerance Test (ETT) after comparing the ETT test results and coronary angiographic findings in true positive and false positive groups.
This Cross-sectional study was conducted at Punjab Institute of Cardiology, Lahore from January 1, 2004 to December 31, 2004. All patients who had ETT done for chest pain diagnosis were studied. Patients were advised coronary angiography if ETT was positive for exercise induced ischaemia. One hundred and forty eight patients had coronary angiography done after positive ETT. Patients were divided into two groups depending upon the angiographic findings, i.e., true positive and false positive. Both groups were compared with each other.
Out of 148 patients, 126 (85.1%) patients had true positive ETT and 22 (14.9%) patients had false positive ETT. The mean age of patients in true positive group was 48.96 +/- 9.08 years and 50.9 +/- 7.85 years in false positive group. One hundred and eighteen (93.7%) male patients and 8 (6.3%) female patients had true positive ETT, whereas 14 (63.6%) males and 8 (36.4%) females had false positive ETT (p < 0.0001). There was no statistically significant difference in the two groups in comparison of age and other conventional risk factors like diabetes mellitus, hypertension, smoking, family history and dyslipidemia. Abnormal resting ECG had a statistically significant diffErence between the groups (p < 0.04), likewise is hypertensive haemodynamic response during ETT (p < 0.003). The symptom limited ETT as compared to no symptoms during ETT also conferred a statistically significant difference between the groups (p < 0.0001). Strongly positive ETT was also associated with true positive ETT (p < 0.002). Amongst the vessels involved the most common was the LAD 113 (89.7%), followed by LCX 80 (63.5%) and the RCA 72 (57.1%). Most of the patients 51 (40.5%) had three vessel disease as compared to SVD 34 (27%).
It can be concluded that amongst the patients who have positive ETT, females with abnormal resting ECG, who achieve target heart rate and have a hypertensive haemodynamic response with no symptoms are likely to have a false positive test result. Conversely male patients with normal resting ECG who do not achieve target heart rate, have a normotensive haemodynamic response and a strongly positive, symptom limited ETT are likely to have a true positive treadmill test result.
通过比较运动耐量试验（ETT）真阳性组和假阳性组的ETT检测结果与冠状动脉造影结果，研究预先决定运动耐量试验阳性患者患冠状动脉疾病的因素。
这项横断面研究于2004年1月1日至2004年12月31日在拉合尔的旁遮普心脏病学研究所进行。对所有因胸痛诊断而进行ETT的患者进行研究。如果ETT对运动诱发缺血呈阳性，则建议患者进行冠状动脉造影。148例患者在ETT阳性后进行了冠状动脉造影。根据造影结果将患者分为两组，即真阳性组和假阳性组。对两组进行相互比较。
148例患者中，126例（85.1%）患者ETT真阳性，22例（14.9%）患者ETT假阳性。真阳性组患者的平均年龄为48.96±9.08岁，假阳性组为50.9±7.85岁。118例（93.7%）男性患者和8例（6.3%）女性患者ETT真阳性，而14例（63.6%）男性和8例（36.4%）女性ETT假阳性（p<0.0001）。两组在年龄以及糖尿病、高血压、吸烟、家族史和血脂异常等其他传统危险因素方面比较，差异无统计学意义。静息心电图异常在两组之间有统计学显著差异（p<0.04），同样，ETT期间的高血压血流动力学反应也有差异（p<0.003）。与ETT期间无症状相比，症状限制性ETT在两组之间也有统计学显著差异（p<0.0001）。强阳性ETT也与真阳性ETT相关（p<0.002）。在所累及的血管中，最常见的是左前降支113例（89.7%），其次是左旋支80例（63.5%）和右冠状动脉72例（57.1%）。与单支血管病变34例（27%）相比，大多数患者51例（40.5%）有三支血管病变。
可以得出结论，在ETT阳性的患者中，静息心电图异常、达到目标心率且有高血压血流动力学反应且无症状的女性可能有假阳性检测结果。相反，静息心电图正常、未达到目标心率、有正常血压血流动力学反应且ETT强阳性、症状限制性的男性患者可能有真阳性平板运动试验结果。
