Schipaanboord Diantha J M, Jansen Tijn P J, Scherpenhuijzen Luuk, Crooijmans Caïa, Dimitriu-Leen Aukelien C, van der Harst Pim, van de Hoef Tim P, van Es René, den Ruijter Hester M, Damman Peter, Onland-Moret N Charlotte, Elias-Smale Suzette E
Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
Int J Cardiol Heart Vasc. 2024 Dec 23;56:101580. doi: 10.1016/j.ijcha.2024.101580. eCollection 2025 Feb.
Recently it has been suggested that coronary microvascular dysfunction (CMD) may explain the high false-positive rate of exercise electrocardiographic stress testing (EST). However, patients with angina but non-obstructive coronary artery disease (ANOCA) present with a broader spectrum of coronary vasomotor dysfunction (CVDys), namely coronary artery spasm (CAS), CMD or a combination of both. We aim to investigate the diagnostic value of EST for the entire CVDys spectrum.
We included patients who underwent coronary function testing (CFT) in the Radboud University Medical Center. For each patient we requested the most recent EST report. ESTs were denoted as positive for ischemia if clinically significant ST-segment depression was detected. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence intervals for the diagnosis of CVDys and its endotypes.
Of the 105 included patients (87 % women, mean age 57 (±8) years), 22 (21 %) had ischemia during EST. CVDys was diagnosed in 94 patients (90 %), of whom 58 patients had an isolated endotype (CAS: n = 51, CMD: n = 7) and 36 patients had CAS and CMD. Ischemia during EST yielded a high specificity and PPV for CVDys (specificity: 100 % (71.5-100 %), PPV: 100 % (84.6-100 %)), which remained reasonably similar for CAS (specificity: 94.4 % (72.7-99.9 %), PPV: 95.5 % (77.2-99.9 %)), but was lower for CMD (specificity: 85.5 % (74.2-93.1 %), PPV: 59.1 % (36.4-79.3 %)).
Ischemia during EST is highly specific for CVDys in general and can be an indicator for CAS and to a lesser extent for CMD in patients with ANOCA.
最近有人提出，冠状动脉微血管功能障碍（CMD）可能解释了运动心电图负荷试验（EST）的高假阳性率。然而，患有心绞痛但冠状动脉无阻塞性疾病（ANOCA）的患者存在更广泛的冠状动脉血管舒缩功能障碍（CVDys），即冠状动脉痉挛（CAS）、CMD或两者兼有。我们旨在研究EST对整个CVDys谱的诊断价值。
我们纳入了在拉德堡大学医学中心接受冠状动脉功能测试（CFT）的患者。对于每位患者，我们索取了最新的EST报告。如果检测到具有临床意义的ST段压低，则将EST判定为缺血阳性。我们计算了诊断CVDys及其亚型的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），并给出95%置信区间。
在纳入的105例患者中（87%为女性，平均年龄57（±8）岁），22例（21%）在EST期间出现缺血。94例患者（90%）被诊断为CVDys，其中58例患者为单一亚型（CAS：n = 51，CMD：n = 7），36例患者同时患有CAS和CMD。EST期间的缺血对CVDys具有高特异性和PPV（特异性：100%（71.5 - 100%），PPV：100%（84.6 - 100%）），对CAS而言保持相当相似（特异性：94.4%（72.7 - 99.9%），PPV：95.5%（77.2 - 99.9%）），但对CMD而言较低（特异性：85.5%（74.2 - 93.1%），PPV：59.1%（36.4 - 79.3%））。
一般而言，EST期间的缺血对CVDys具有高度特异性，并且在ANOCA患者中可以作为CAS的指标，对CMD的指示作用较小。
