Capabilities of the Treadmill Test in Modern Cardiological Practice
Abstract
Many publications in recent years have been dedicated to the search for the best preliminary method of diagnosing coronary artery disease (CAD), where the availability of technology and staff experience are the determining factors. According to the National Cardiovascular Data Registry of the American College of Cardiology, 58.4% of patients referred for coronary angiography after functional testing do not have significant coronary artery stenoses. European guidelines for the diagnosis and management of patients with chronic coronary syndrome recommend the use of imaging diagnostic tests instead of exercise electrocardiography for the diagnosis of obstructive CAD.
The aim. To analyze the capabilities of the exercise electrocardiography test for patients in modern cardiological practice.
Materials and methods. A treadmill test was performed on 406 patients, among whom 317 (78.07%) were men, 89 (21.9%) were women, the mean age was 44.7±17.3 years. The test was carried out according to the Bruce protocol on the Valiant Ergometric Treadmill.
Results. The patients were divided into groups depending on the area of diagnostic search: verification of CAD in cardiac pain (n=184); evaluation of the long-term results of cardiac surgery (n=74); visualization of myocardial ischemia in borderline stenoses of coronary arteries (n=4); screening in the presence of additional CAD risk factors (n=49); in the case of heart rhythm disorders in order to decide on further treatment tactics and evaluation of the effectiveness of the antiarrhythmic treatment (n=34); evaluation of the coronary artery in patients with congenital heart defects (n=7); determination of tolerance to physical exertion (n=54). Among the examined patients, there were 48 (11.8%) with positive, 246 (60.5%) with negative, and 112 (27.5%) with doubtful treadmill test. Among 48 patients with a positive treadmill test, myocardial revascularization was performed in 41 (85.4%) cases.
Conclusions. Exercise electrocardiography is an affordable tool for diagnostic research which, with its high-quality performance and interpretation, can be an alternative to modern imaging techniques.
References
- Genders TS, Petersen SE, Pugliese F, Dastidar AG, Fleischmann KE, Nieman K, et al. The Optimal Imaging Strategy for Patients With Stable Chest Pain: A Cost-Effectiveness Analysis. Ann Intern Med. 2015;162(7):474-484. https://doi.org/10.7326/M14-0027
- Michos ED, Greenland P. Coronary Computed Tomography Angiography in Stable Chest Pain to Prevent Myocardial Infarction and Reduce Costs-Seeing Is Believing. JAMA Netw Open. 2020;3(12):e2030996. https://doi.org/10.1001/jamanetworkopen.2020.30996
- Berry C, Kramer CM, Kunadian V, Patel TR, Villines T, Kwong RY, et al. Great Debate: Computed tomography coronary angiography should be the initial diagnostic test in suspected angina. Eur Heart J. 2023;44(26):2366-2375. https://doi.org/10.1093/eurheartj/ehac597
- Dzakhoieva LS, Gogayeva OK, Rudenko AV, Lazoryshynets VV. [The value of perioperative ECG in patients with complicated forms of coronary artery disease]. Zaporozhye medical journal. 2021;23(1):11-16. Ukrainian. https://doi.org/10.14739/2310-1210.2021.1.224977
- Patel MR, Dai D, Hernandez AF, Douglas PS, Messenger J, Garratt KN, et al. Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. Am Heart J. 2014;167(6):846-852.e2. https://doi.org/10.1016/j.ahj.2014.03.001
- Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(3):407-477. https://doi.org/10.1093/eurheartj/ehz425
- Knuuti J, Ballo H, Juarez-Orozco LE, Saraste A, Kolh P, Rutjes AWS, et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur Heart J. 2018;39(35):3322-3330. https://doi.org/10.1093/eurheartj/ehy267
- Shaw LJ, Mieres JH, Hendel RH, Boden WE, Gulati M, Veledar E, et al.; WOMEN Trial Investigators. Comparative Effectiveness of Exercise Electrocardiography With or Without Myocardial Perfusion Single Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease: Results From the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial. Circulation. 2011;124(11):1239-1249. https://doi.org/10.1161/CIRCULATIONAHA.111.029660
- Riley RF, Batchelor WB, Goldstein JA, Al-Lamee R, Shah S, Tremmel JA, et al. The 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain: An Interventionalist’s Viewpoint. J Soc Cardiovasc Angiogr Interv. 2022;1(3):100305. https://doi.org/10.1016/j.jscai.2022.100305
- Blankstein R, Shaw LJ, Gulati M, Atalay MK, Bax J, Calnon DA, et al. Implications of the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline for Cardiovascular Imaging: A Multisociety Viewpoint. JACC Cardiovasc Imaging. 2022;15(5):912-926. https://doi.org/10.1016/j.jcmg.2022.02.021
