Ruolo diagnostico del test da sforzo con analisi dell’isteresi ST/HR nei pazienti con stenosi aortica severa asintomatica
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Data di Pubblicazione:
2018
Citazione:
Ruolo diagnostico del test da sforzo con analisi dell’isteresi ST/HR nei pazienti con stenosi aortica severa asintomatica / F. Fulgenzi, F. Radico, M. Zimarino, M. Mapelli, P. Agostoni, R. De Caterina. ((Intervento presentato al 79. convegno Congresso Società Italiana di Cardiologia (SIC) tenutosi a Roma nel 2018.
Abstract:
Background
Although recommended by current guidelines, the exercise ECG stress test (ExET) is
underused for the diagnostic workup of asymptomatic patients with severe aortic stenosis
(AS), due to safety concerns and poor accuracy of the method for coronary artery disease
(CAD) detection. We hypothesized that the ST-segment/heart rate (ST/HR) hysteresis
increases the diagnostic performance of ExET for CAD detection in asymptomatic patients
with severe AS.
Methods We prospectively analysed patients with severe asymptomatic AS referred to 5
cardiology centers in Italy, Belgium and France. Patients underwent invasive coronary
angiography (ICA) within a month from the ExET. Coupled ST-T segment depression
values and HR measurements for ST/HR hysteresis calculations were processed by an
ad-hoc home-made software. Receiver-operating characteristic (ROC) analysis was
performed to test the discriminative capacity of ST/HR hysteresis and maximum ST
depression (ST-max) at ExET in detecting CAD.
Results Among the 30 included patients (mean age 77±8 years, 77% males), CAD was
detected in 14 cases (47%). At ROC analysis, the ST/HR hysteresis achieved a better
diagnostic performance (AUC 0.82; 95% CI 0.72 – 0.94, P <0.01 vs neutral AUC) than the
ST-max criterion (AUC 0.58; 95% CI 0.42 – 0.71, P=NS vs neutral AUC). Pairwise
comparison demonstrated a significant difference between the two AUCs (0.24, 95% CI
0.02 to 0.41, P<0.05), with better performance of the ST-HR hysteresis.
Conclusion The ST/HR hysteresis improves the diagnostic performance of ExET for CAD
detection in asymptomatic patients with severe AS.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
F. Fulgenzi, F. Radico, M. Zimarino, M. Mapelli, P. Agostoni, R. De Caterina
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