CORONARY-ARTERY DISEASE AND HYPERTENSION - IMPROVEMENT OF THE ACCURACY OF EXERCISE TESTS BY USING HEART-RATE ADJUSTED ST SEGMENT DEPRESSION

Hypertensive patients complaining of chest pain often have a normal co ronary angiogram despite a pathological exercise tolerance test. The a im of the present study was to establish whether the prevalence of the se ''false-positive'' tests could be lowered by adjusting ST segment d epression for exercise-induced increase in heart rate. Methods : 60 hy pertensive patients, mean age 59 years, with typical or atypical chest pain, underwent both a symptom-limited exercise test and a coronary a ngiogram within a median period of 1 day. The ST segment depression wa s measured every 20 ms from the J point. A stepwise discriminant analy sis was performed: a canonical variable took into account the Detrano index, the quantified rate-recovery loop index (QRL index) as well as the presence of a LV hypertrophy (RomhiIt Estes Score). Results: [GRAP HICS] Conclusion : in hypertensive patients with chest pain, the speci ficitiy and the positive predictive value of exercise test are signifi cantly improved by adjusting ST segment depression for heart rate both during effort and recovery and by taking into account the score of Ro mhilt Estes on the baseline ECG recording.