FREQUENCY OF SIGNIFICANT CORONARY ARTERY DISEASE IN CASES WITH ST SEGMENT DEPRESSION DURING RECOVERY PHASE OF EXERCISE

Authors

  • U FAROOQ Department of cardiology, Rehmatul-lil-Alamen institute of cardiology, PESSI, Lahore, Pakistan
  • N ULLAH Department of cardiology, Rehmatul-lil-Alamen institute of cardiology, PESSI, Lahore, Pakistan
  • AE QURESHI Department of cardiology, Rehmatul-lil-Alamen institute of cardiology, PESSI, Lahore, Pakistan
  • M SAJJAD Department of cardiology, Gulab Devi Hospital Lahore, Pakistan
  • H ANUM Department of cardiology, Rehmatul-lil-Alamen institute of cardiology, PESSI, Lahore, Pakistan
  • WA DAR Department of Cardiology, Punjab cardiac and medical center Ravi Road Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.236

Keywords:

Significant coronary artery disease, ST Segment depression, Exercise tolerance test

Abstract

Coronary Artery Disease (CAD) imposes physical, social, and economic burden. It is amongst the leading causes of mortality and morbidity. Exercise-induced ST segment depression is considered  reliable ECG finding for the diagnosis of obstructive coronary atherosclerosis. Exercise testing has an excellent safety record. The aim of the study is to determine the frequency of significant coronary artery  disease  in  cases  with  ST-segment depression during recovery phase of exercise tolerance test. This descriptive case series was carried out at the Department of Cardiology,   Rehmatul-Lil-Alamin Institute of Cardiology, Lahore, from 11-01-2021 to 10-07-2021. A total of 89 patients were taken in this study. Conventional coronary angiography via femoral or radial route was performed. Lesions were quantified by QCA technique in addition to visual assessment. Significant CAD was labelled as per operational definition. Patients ranged between 30-70 years of age with mean age of 51.8±10.8 years. There were 56 males (62.9%) while remaining 33 (37.1%) were females. History of diabetes mellitus was reported in 31 patients (34.8%), hypertension in 38 patients (42.7%) and smoking 51 (57.3%). Family history of CAD found in 46 patients (51.7%). Hyperlipidemia reported in 38 patients (42.7%). Significant CAD was observed in 76 patients (85.4%).   Stratification   for   age,   gender,   diabetes mellitus, hypertension and smoking were carried out and found no association with significant CAD. In conclusion, 85.4% frequency rate of significant coronary artery disease in cases with ST segment depression during recovery phase of exercise tolerance test   was   observed.   Thus,   careful   evaluation   of   ST segment depression occurring in recovery phase may add significantly to the clinical information derived from the results of ETT.

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References

Ashley, E. A., Raxwal, V., and Froelicher, V. (2001). An evidence-based review of the resting electrocardiogram as a screening technique for heart disease. Progress in cardiovascular diseases 44, 55-67.

Chou, R., and Physicians*, H. V. C. T. F. o. t. A. C. o. (2015). Cardiac screening with electrocardiography, stress echocardiography, or myocardial perfusion imaging: advice for high-value care from the American College of Physicians. Annals of internal medicine 162, 438-447.

Edition, S. (2010). Preventive Services for Adults.

Ishtiaq, O., Ahmed, M., Anwer, F., Khalid, M. A., and Mehmood, A. (2002). evaluation of exercise stress test for coronary artery disease and outcome. J. Coll. Physicians Surg. Pak, 721-724.

Kavi, G. (2021). Diagnostic Value of St Depression in Both Exercise and Recovery Phase of Treadmill Test. INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY 9, 92-96.

Khan, M. S., Khan, A., Ali, A., Akhtar, N., Rasool, F., Khan, H., ur Rehman, N., and Shah, S. H. (2016). Prevalence of risk factors for coronary artery disease in Southern Punjab, Pakistan. Tropical Journal of Pharmaceutical Research 15, 195-200.

Krishnan, M., Zachariah, G., Venugopal, K., Mohanan, P., Harikrishnan, S., Sanjay, G., Jeyaseelan, L., and Thankappan, K. (2016). Prevalence of coronary artery disease and its risk factors in Kerala, South India: a community-based cross-sectional study. BMC cardiovascular disorders 16, 1-12.

Members, C., Gibbons, R. J., Balady, G. J., Timothy Bricker, J., Chaitman, B. R., Fletcher, G. F., Froelicher, V. F., Mark, D. B., McCallister, B. D., and Mooss, A. N. (2002). ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 106, 1883-1892.

Miller, T. D., Askew, J. W., and Anavekar, N. S. (2016). Noninvasive stress testing for coronary artery disease. Heart Failure Clinics 12, 65-82.

Narayanapillai, J., Madhavan, S., Rajendran, D., and George, R. (2015). ‘Recovery only’vs.‘during exercise’ST segment depression in exercise stress test–Clinical & angiographic correlation. journal of indian college of cardiology 5, 305-309.

Nazar, S., Farhan, S., and Tasneem, U. (2017). Association of serum Omentin-1 levels with coronary artery disease (CAD) in a local population of Karachi-A multicenter study. ANNALS OF ABBASI SHAHEED HOSPITAL AND KARACHI MEDICAL & DENTAL COLLEGE 22, 31-36.

Savage, M. P., Squires, L. S., Hopkins, J. T., Raichlen, J. S., Park, C. H., and Chung, E. K. (1987). Usefulness of ST-segment depression as a sign of coronary artery disease when confined to the postexercise recovery period. The American journal of cardiology 60, 1405-1406.

Sharieff, S., and Khan, S.-e.-Z. (2002). Exercise Tolerance Test in patients presenting with chest pain and normal electrocardiogram. JCPSP. Journal of the College of Physicians and Surgeons Pakistan 12, 348-352.

Shrief, S., and Zaman, K. (2002). Sensitivity and specificity of exercise tolerance test in patients with chest pain and normal base line ECG. Pak J Cardiol 13, 91-5.

Soto, J. R., Watson, D. D., and Beller, G. A. (2001). Incidence and significance of ischemic ST-segment depression occurring solely during recovery after exercise testing. American Journal of Cardiology 88, 670-672.

Srivatsa, A., Bui, J., Mahdi, A. A., and Amsterdam, E. A. (2020). Frequency and Influence of Exercise-Induced Artifact in Electrocardiograms During Exercise Treadmill Testing for Detection of Myocardial Ischemia. Critical Pathways in Cardiology 19, 75-78.

Kasemy, Z. A., Hathout, H. M., Omar, Z. A., Samir, M. A., and Bahbah, W. A. (2020). Effect of Omega-3 supplements on quality of life among children on dialysis: a prospective cohort study. Medicine 99.

Kuo, K., Hung, S., Tseng, W., Tsai, M., Liu, J., Lin, M., Hsu, C., and Tarng, D. (2018). Taiwan Society of Nephrology Renal Registry Data. Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM—HD Study. J. Am. Heart Assoc 7, e009206.

Li, P., Garcia-Garcia, G., Lui, S.-F., Andreoli, S., Fung, W., Hradsky, A., Kumaraswami, L., Liakopoulos, V., Rakhimova, Z., and Saadi, G. (2020). Kidney health for everyone everywhere–from prevention to detection and equitable access to care. Brazilian Journal of Medical and Biological Research 53.

Liyanage, T., Ninomiya, T., Jha, V., Neal, B., Patrice, H. M., Okpechi, I., Zhao, M.-h., Lv, J., Garg, A. X., and Knight, J. (2015). Worldwide access to treatment for end-stage kidney disease: a systematic review. The Lancet 385, 1975-1982.

Norris, K., Mehrotra, R., and Nissenson, A. R. (2008). Racial differences in mortality and ESRD. American Journal of Kidney Diseases 52, 205-208.

Panday, V. B., Tong, Z.-P., Ng, P. L., Lee, E. J., Lau, T., Teo, B.-W., and Chua, H.-R. (2014). Dialysis modality and 2-year outcomes in patients with ischemic cardiomyopathy and end-stage renal disease. International journal of cardiology 176, 1097-1099.

Park, K. S., Ryu, G. W., Jhee, J. H., Kim, H. W., Park, S., Lee, S. A., Kwon, Y. E., Kim, Y. L., Ryu, H. J., and Lee, M. J. (2015). Serum ferritin predicts mortality regardless of inflammatory and nutritional status in patients starting dialysis: a prospective cohort study. Blood Purification 40, 209-217.

Robinson, B. M., Zhang, J., Morgenstern, H., Bradbury, B. D., Ng, L. J., McCullough, K. P., Gillespie, B. W., Hakim, R., Rayner, H., and Fort, J. (2014). Worldwide, mortality risk is high soon after initiation of hemodialysis. Kidney international 85, 158-165.

Swartling, O., Rydell, H., Stendahl, M., Segelmark, M., Lagerros, Y. T., and Evans, M. (2021). CKD progression and mortality among men and women: a nationwide study in Sweden. American Journal of Kidney Diseases 78, 190-199.

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Published

2023-04-10

How to Cite

FAROOQ, U., ULLAH, N., QURESHI, A., SAJJAD, M., ANUM, H., & DAR, W. (2023). FREQUENCY OF SIGNIFICANT CORONARY ARTERY DISEASE IN CASES WITH ST SEGMENT DEPRESSION DURING RECOVERY PHASE OF EXERCISE. Biological and Clinical Sciences Research Journal, 2023(1), 236. https://doi.org/10.54112/bcsrj.v2023i1.236

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