Key result
An abnormal diastolic blood pressure increase during exercise in CAD patients correlated with lower resting ejection fraction (46.3% vs 61.6%, p<=0.001) but not with the number of obstructed vessels.
Why the study?
Does an abnormal response of diastolic blood pressure during treadmill exercise stress testing correlate with the number of obstructed vessels and left ventricular systolic function in patients with coronary artery disease?
Cross-Sectional (n=50)
Yes
Does an abnormal response of diastolic blood pressure during treadmill exercise stress testing correlate with the number of obstructed vessels and left ventricular systolic function in patients with coronary artery disease?
Absolute Event Rate: 46.3% vs 61.6%
p-value: p=<=0.001
An abnormal increase in diastolic blood pressure during exercise stress testing in patients with coronary artery disease correlates with impaired resting left ventricular systolic function, suggesting it may serve as an index of latent ventricular dysfunction.
May flag latent LV dysfunction in CAD; hypothesis-generating and should not yet change practice.
OBJECTIVE: To determine whether an abnormal response of diastolic blood pressure during treadmill exercise stress testing correlated with the number of obstructed vessels and with left ventricular systolic function in patients with coronary artery disease. DESIGN: Diastolic blood pressure was measured invasively during exercise stress testing and coronary angiograms and left ventriculograms were obtained at rest in patients with coronary artery disease. The abnormal (> or = 15 mm Hg) diastolic blood pressure response was compared with the number of obstructed coronary arteries and with left ventricular systolic function. SETTING: Two tertiary referral centres. PATIENTS: 50 consecutive patients (mean age 57 years) with coronary artery disease. MAIN OUTCOME MEASURES: The increase in diastolic blood pressure during exercise and its correlation with the appearance and disappearance of ST segment deviation, resting left ventricular systolic function, and the number of obstructed coronary arteries. RESULTS: Group 1: 10 (20%) patients (three with one, four with two, and three with three vessel coronary artery disease) (mean (SD) age 54.7 (12) years) had an abnormal diastolic blood pressure response that appeared 1.2 (0.3) min before ST segment deviation and became normal 0.9 (0.3) min after the ST segment returned to normal. Group 2: 40 (80%) patients (12 with one, 16 with two, and 12 with three vessel coronary arteries disease) (aged 56.8 (8.2) years) had a normal diastolic blood pressure response to stress testing. The ejection fraction (46.3 (5)%) and cardiac index (2.6 (0.1) 1/min/m2) in group 1 were less than in group 2 (61.6 (4.2)% and 3.8 (0.3) 1/min/m2 respectively, p < or = 0.001). The end systolic volume was greater in group 1 than in group 2: 38.7 (0.7 ml/m2 v 28.2 (2.1) ml/m2, p < or = 0.001. CONCLUSION: In patients with coronary artery disease an abnormal increase in diastolic blood pressure during exercise stress testing correlated well with left ventricular systolic function at rest but not with the number of obstructed coronary arteries. The abnormal response of diastolic blood pressure probably reflects deterioration of myocardial function.
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Paraskevaidis et al. (1993) conducted a cross-sectional in coronary artery disease (n=50). Abnormal diastolic blood pressure response (≥15 mm Hg) during exercise vs. Normal diastolic blood pressure response was evaluated on Resting left ventricular ejection fraction (p=<=0.001). An abnormal diastolic blood pressure increase during exercise in CAD patients correlated with lower resting ejection fraction (46.3% vs 61.6%, p<=0.001) but not with the number of obstructed vessels.
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