EXERCISE TESTING AND LEFT MAIN CORONARY ARTERY DISEASE: EXPERIENCE WITH 57 PATIENTS

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RESUMO

Results of multistage treadmill tests (TMT) of 57 patients with critical stenosis (≥ 50%) of the left main coronary artery were analyzed. Additional disease was present in the major vessel in three patients (5%), two vessels in 18 patients (32%), and three vessels in 35 patients (61%). The TMT was negative for ischemia in only two patients (4%), positive in 51 (89%), and undetermined in 4 (7%). TMT was strongly positive (≥ 2 mm ST segment depression) in 40 patients (70%), and in 11 (19%) of these, ST depression was ≥ 3 mm. Hypotension with exercise was rare and was encountered in only one patient. Arrhythmias were induced with exercise in six patients (10%) and resulted in premature termination of TMT in four. TMT was terminated due to early ST segment depression in 40 patients (70%), in 17 (30%) without chest pain—an unusual finding. Exercise was limited to stage I (Bruce protocol) in 16 (28%), stage II in 26 (46%), stage III in ten (17%), and stage IV in five (9%). Mean exercise tolerance was 298 ± 22 seconds (SEM). Maximum heart rate (HR) achieved was 76 ± 2% of their maximal predicted values. Peak double product (systolic BP × HR) was 20490 ± 830.

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