The Usefulness Of Heart Rate And Blood Pressure Recovery In Diagnosis Of Coronary Artery Disease In Hypertensive Women With Suspected Coronary Artery Disease: From Korean Women'S Chest Pain Registry (Korose)

Objective: In women, the evaluation for cardiac autonomic dysfunction may improve the diagnostic accuracy of exercise treadmill test (ETT). But cardiac autonomic dysfunction is frequently impaired in hypertension and the diagnostic usefulness in hypertension has not been evaluated. We investigate whether the additional assessment of autonomic functional parameters to ischemic EKG changes on ETT would improve the diagnostic accuracy for coronary artery stenosis (CAS) in female hypertensive patient with suspected CAS. Design and Method: 144 female hypertensive patients (mean age 62.2 ± 9.3) from a KoROSE registry were analyzed. The definition of significant CAS was >50% luminal narrowing of at least one coronary artery by coronary angiography. All patients underwent a symptom-limited treadmill exercise test. Ischemic ST changes were defined as > 1 mm of horizontal or down-sloping depression 80ms after the J point in 2 contiguous leads. Autonomic dysfunction was assessed by heart rate recovery (HRR) and blood pressure response (BPR) after exercise. Delayed HRR was defined as < 18 /min decrease at 1minute after exercise termination. Delayed BPR was defined as systolic blood pressure > 178 mmHg at 2 minute after exercise. Diagnostic accuracy was calculated. Results: Significant CAS was detected in 51 patients (35.4%). Sensitivity, specificity, PPV and NPV of ischemic EKG for prediction of CAD were 44%, 74%, 48% and 71% respectively. But after adding delayed HRR and BP to ischemic ST change, sensitivity and NPV was increased to 73% and 78%, respectively. But specificity and PPV was significantly decreased to 46% and 54%, respectively. And overall diagnostic accuracies were not different between 2 examinations (63.1% and 60.8%). Conclusions: The addition of delayed HRR and BPR after exercise improved the sensitivity but worsened specificity of ETT to detect CAS in hypertension. This findings suggests that impaired cardiac autonomic function was related with decreased myocardial perfusion caused by myocardial fibrosis or diastolic dysfunction, rather than fixed epicardial coronary stenosis