The value of hemodynamic changes induced by carotid sinus massage on the diagnosis of coronary artery disease

The aim of this study is to investigate the value of hemodynamic changes in duced by Carotid sinus massage (CSM) on the diagnosis of coronary artery di sease (CAD). A total 108 patients (mean age, 54 +/- 10 years, range 33-70) who had no significant stenosis in the carotid artery by duplex ultrasonogr aphy (USG) and no history of syncope were included in this study. Carotid s inus massage was performed before coronary angiography with monitoring of e lectrocardiography and blood pressure. The patients were divided into three groups according to response to CSM: group 1 patients had a decrease in bl ood pressure or < 10 beats/minute (bpm); group 2 patients had a decrease be tween 10 and 20 bpm; and group 3 patients had > 20 mm Hg decrease in blood pressure or > 20 bpm. Coronary angiography was performed after CSM in all p atients. There was single-vessel disease (VD) in 23 cases, two-VD in 24 cas es, and three-VD in 35 cases. Coronary angiography results were normal in 2 6 cases. The changes in systolic and diastolic blood pressures and heart ra te before and after CSM correlated with number of VD. These changes were hi ghest in patients with three-VD, but lowest in patients with normal coronar y angiography. The number of diseased vessels and total coronary artery sco re were lowest in group 1, but highest in group B. The specificity and sens itivity of CSM-induced > 10 mm Hg in blood pressure (BP) or > 10 bpm change s in heart rate in the diagnosis of CAD were 85% and 71%, respectively. The positive and negative predictive values were 93% and 49%, respectively in the diagnosis of CAD. At the end of this study, we concluded that CSM induc ed the fall in blood pressure and heart rate and was correlated with number of diseased vessels and the score of coronary artery disease. As dichotomi zed values, the decrease of > 10 mm Hg in blood pressure and/or > 10 bpm ha s highest specificity, sensitivity, and positive predictive value in the di agnosis of CAD.