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Age, ECG parameters improved diagnostic accuracy of treadmill test
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When used in conjunction with an ECG, the exercise treadmill test may be an accessible, economic and easy-to-use diagnostic tool for predicting CAD in women aged 65 years and older, data published in the American Journal of Cardiology indicate.
Researchers at the University of California Davis Medical Center in Sacramento evaluated women with chest pain who had positive exercise treadmill test results and subsequent coronary angiography. Of the 111 women, 56 had significant CAD on angiogram, yielding a positive predictive value of 51% for the group. However, inclusion in the analysis of several pretest attributes and specific exercise test responses improved the positive predictive value of the exercise treadmill test.
“Newer cardiac imaging technologies are more accurate in identifying the presence of heart disease, but those tests are considerably more expensive than [exercise treadmill test] and in many cases unnecessary,” senior study researcher Ezra Amsterdam, MD, of the division of cardiovascular medicine at the University of California Davis Medical Center, said in a press release. “Our study found that the test is a very valuable tool for identifying coronary artery disease in women older than 65 and that it can be used to help select those who may require higher-tech diagnostics.”
Age had a major effect, with the youngest group (35 to 50 years) having a positive predictive value of 36% compared with 68% in the oldest group (>65 years). Specific ECG exercise responses — ST-segment depression >2 mm and delayed ST-segment recovery >3 minutes — further separated true from false positives across all age groups, increasing the positive predictive value to approximately 80%. Onset of ischemia at a low cardiac workload of <80% maximum predicted heart rate increased positive predictive value from 22% to 50% in patients aged 35 to 50 years, from 39% to 61% in those aged 51 to 65 years and from 62% to 77% in those aged older than 65 years. However, this effect was not significant, according to study results.
“Our results provide physicians with a way to make an old heart disease screening tool more reliable for women,” Amsterdam said. “The study also supports the guidelines of the American Heart Association and America College of Cardiology, which recommend that exercise treadmill testing should remain the initial test for both women and men who require evaluation for chest pain.”
Disclosure:The researchers report no relevant financial disclosures.
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