EVALUATING THE DIAGNOSTIC ACCURACY OF EXERCISE TOLERANCE TEST IN DETECTING CORONARY ARTERY DISEASE: A STUDY CORRELATING RESULTS WITH ANGIOGRAPHIC FINDINGS AT AYUB TEACHING HOSPITAL, ABBOTTABAD, PAKISTAN"
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Abstract
Background: The exercise tolerance test (ETT) and coronary angiography are widely used diagnostic tools to assess patients with suspected ischemic heart disease. Coronary angiography remains the gold standard for diagnosing coronary artery disease (CAD). This study evaluates the positive predictive value (PPV) of ETT for diagnosing CAD, using coronary angiography as the reference standard.
Methods: This cross-sectional study was conducted at Ayub Teaching Hospital, Abbottabad, Pakistan, from January 15, 2023, to july 25, 2023. A total of 95 patients with positive ETT results were included after applying strict inclusion and exclusion criteria. All patients underwent coronary angiography following their ETT. Data were collected using a structured proforma and analyzed using the Statistical Package for Social Sciences (SPSS), version 23 (IBM Corp., Armonk, NY). The PPV of ETT was calculated across various demographic and clinical parameters.
Results: Among the 95 patients, 77 were male, and 18 were female, with a mean age of 53.3 ± 7.6 years. Of the study population, 35.1% had type-2 diabetes mellitus, and 31.9% were hypertensive. Coronary angiography revealed significant coronary artery occlusion (≥70% stenosis) in 70 patients, while 25 had normal angiographic findings. The overall PPV of ETT for diagnosing CAD was calculated at 73.4%. Subgroup analysis showed that the PPV was higher among males, smokers, diabetics, and non-hypertensive patients, while it was comparatively lower in females, non-smokers, non-diabetics, and hypertensive.
Conclusion: Our findings suggest that a positive ETT result has a notable likelihood of false positivity in certain subsets of the population, particularly females, non-smokers, hypertensive individuals, and non-diabetics. Clinicians should exercise caution when interpreting ETT results in these groups. While coronary angiography provides definitive anatomical information, it does not assess myocardial function under stress. Therefore, further studies integrating non-invasive imaging modalities, such as stress echocardiography or myocardial perfusion imaging, are recommended for a more comprehensive evaluation in these patients.
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Muhammad Abbas Khan
PGY - IV, internal medicine, MTI, Ayub Teaching Hospital, Abbottabad, Kpk, Pakistan.
Salman Khan Khattak
Final Year MBBS Students, Abbottabad International Medical College, Abbottabad, Kpk, Pakistan.
Waleed Asif Khurshid
Medical Officer, Armed Forces Institute of Urology (AFIU), Rawalpindi, Pakistan.
Yasir Zeb
PGY - III cardiology, Ayub Teaching Hospital Abbottabad, Kpk, Pakistan.
Uffaq Sandeela
Medical Officer, Begum Akhter Rukhsana Memorial Trust, Safari Hospital Pakistan.
Bushra Shaheen
Final year Student City University of science and information Peshawar Pakistan.
Khan Ifrah Shahid
Emergency medical officer Alhaseeb medical complex rawalakot poonch AJK Pakistan
Irfan Ullah
Emergency medical officer Alhaseeb medical complex rawalakot poonch AJK Pakistan
Talha Ilyas Khan
4th Year MBBS Students, Abbottabad International Medical College, Abbottabad, Kpk, Pakistan.
Maria Saleem
General Practitioner, Rehman Memorial Hospital Complex, Haripur, Pakistan