Diagnostic Methods Coronary Artery Disease

It has been previously reported that at treadmill exercise testing an abnormal ratio of recovery systolic blood pressure (SBP) to peak exercise SBP is more sensitive than exercise-induced angina or ST segment depression for diagnosing coronary artery disease (CAD). To investigate whether the SBP ratio keeps its diagnostic value during upright bicycle exercise, we evaluated the ratio of postexercise SBP to peak SBP in 73 patients with angiographically documented CAD and in 48 patients with normal coronary arteries (OV group) undergoing maximal stress testing on a bicycle ergometer. Three minutes after exercise ended, SBP ratio was significantly higher in the CAD than in the OV group (0.79 ± 0.1 vs 0.71 + 0.08; p < .001). Setting the upper normal limits of the recovery SBP ratio at 2 SDs from the mean for the OV group (SBP ratio = 0.98 and 0.88 at 1 and 3 min after exercise, respectively), with an increase or no change in SBP ratio at between 1 and 3 min of recovery considered an abnormal response, the sensitivity of SBP ratio was 30%, the specificity was 83%, and the accuracy was 51%. The respective values for ST depression were 81% (p < .0001 vs SBP ratio), 48% (p < .001 vs SBP ratio), and 67% (p < .01 vs SBP ratio). Thus, for bicycle ergometer exercise testing, ST segment depression seems to be more accurate than SBP ratio in diagnosing CAD. Circulation 77, No. 6, 1306-1310, 1988. THE RATIO of postexercise systolic blood pressure (SBP) to peak exercise SBP at treadmill exercise testing has been proposed by Amon et al.' as a highly sensitive and specific index for diagnosing coronary artery disease (CAD). The diagnostic value of this criterion has been more recently confirmed at treadmill exercise testing in a small study population,2 but the usefulness of the ratio of recovery SBP to peak exercise SBP during bicycle exercise testing remains to be assessed. The purpose of the present study was to verify the ability of the criterion to diagnose CAD during exercise testing on the bicycle ergometer.