运动应激试验时的缺血是冠状动脉血管舒缩功能障碍的一种指征？

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-02-01 DOI:10.1016/j.ijcha.2024.101580

Diantha J.M. Schipaanboord , Tijn P.J. Jansen , Luuk Scherpenhuijzen , Caïa Crooijmans , Aukelien C. Dimitriu-Leen , Pim van der Harst , Tim P. van de Hoef , René van Es , Hester M. den Ruijter , Peter Damman , N. Charlotte Onland-Moret , Suzette E. Elias-Smale , on behalf of the IMPRESS consortium

{"title":"运动应激试验时的缺血是冠状动脉血管舒缩功能障碍的一种指征？","authors":"Diantha J.M. Schipaanboord , Tijn P.J. Jansen , Luuk Scherpenhuijzen , Caïa Crooijmans , Aukelien C. Dimitriu-Leen , Pim van der Harst , Tim P. van de Hoef , René van Es , Hester M. den Ruijter , Peter Damman , N. Charlotte Onland-Moret , Suzette E. Elias-Smale , on behalf of the IMPRESS consortium","doi":"10.1016/j.ijcha.2024.101580","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 %)).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101580"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728068/pdf/","citationCount":"0","resultStr":"{\"title\":\"Ischemia during exercise stress testing, an indication of coronary vasomotor dysfunction?\",\"authors\":\"Diantha J.M. Schipaanboord , Tijn P.J. Jansen , Luuk Scherpenhuijzen , Caïa Crooijmans , Aukelien C. Dimitriu-Leen , Pim van der Harst , Tim P. van de Hoef , René van Es , Hester M. den Ruijter , Peter Damman , N. Charlotte Onland-Moret , Suzette E. Elias-Smale , on behalf of the IMPRESS consortium\",\"doi\":\"10.1016/j.ijcha.2024.101580\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 %)).</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":38026,\"journal\":{\"name\":\"IJC Heart and Vasculature\",\"volume\":\"56 \",\"pages\":\"Article 101580\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728068/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"IJC Heart and Vasculature\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S235290672400246X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"IJC Heart and Vasculature","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S235290672400246X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

摘要

背景：最近有研究认为冠脉微血管功能障碍（CMD）可能是运动心电图负荷测试（EST）假阳性率高的原因。然而，心绞痛但非阻塞性冠状动脉疾病（ANOCA）的患者表现为更广泛的冠状动脉血管舒张功能障碍（CVDys），即冠状动脉痉挛（CAS）、CMD或两者兼有。我们的目的是探讨EST对整个CVDys谱的诊断价值。方法：我们纳入了在内梅亨大学医学中心接受冠状动脉功能测试（CFT）的患者。对于每个病人，我们都要求提供最近的EST报告。如果检测到有临床意义的st段抑制，则ESTs检测为缺血阳性。我们以95%的置信区间计算了CVDys及其内型诊断的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。结果：105例患者（87%为女性，平均年龄57（±8）岁），22例（21%）在EST期间出现缺血，94例（90%）诊断为CVDys，其中58例为孤立型（CAS: n = 51, CMD: n = 7）， 36例合并CAS和CMD。EST期间缺血对CVDys产生高特异性和PPV(特异性：100% (71.5- 100%),PPV: 100%(84.6- 100%))，对CAS保持合理相似(特异性：94.4% (72.7- 99.9%),PPV: 95.5%(77.2- 99.9%))，但对CMD较低(特异性：85.5% （74.2- 93.1%),PPV: 59.1%(36.4- 79.3%)）。结论：EST期间的缺血通常对CVDys具有高度特异性，可以作为CAS的一个指标，在ANOCA患者中，在较小程度上可以作为CMD的一个指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Ischemia during exercise stress testing, an indication of coronary vasomotor dysfunction?

查看原文本刊更多论文

Ischemia during exercise stress testing, an indication of coronary vasomotor dysfunction?

Background

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.

Methods

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.

Results

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 %)).

Conclusions

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.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.