The Relationship of Electrocardiographic Changes, Coronary Angiographic Finding and Duke Treadmill Score In Positive Treadmill Test Patients

Abstract

Ischemic heart disease is a leading cause of death worldwide which may present as a stable ischemic heart disease . The diagnosis depend on history and clinical examination in addition to electrocardiography and echocardiography.  In  patients  with  normal  electrocardiography  and echocardiography and have low to intermediate risk of ischemic heart disease, we need another tools like exercise stress test which include duke treadmill score as a composite score to evaluate  the patient with ischemic  heart  disease.  SYNTAX  score  is  an  angiographic  scoring system that is widely used to evaluate the severity and complexity of cardiovascular disease in catheterization laboratory.
The aim to look at the prevalence of ischemic heart disease and its culprit   electrocardiography   changes   during   or   after   exercise   and calculate  duke  treadmill  score.  Then  after  prospectively  looking  at coronary angiographic findings and its syntax score. To assess if there any   anatomical   association   between   positive   electrocardiographic changes,  coronary angiography and duke treadmill score.
            A  cross  sectional  study,  out  of  280  patients  who  attended exercise treadmill test unit in Saladin General Hospital during the period from June 2017 to June  2019, one hundred patients of them had positive stress test. sixteen  patients refused coronary angiography and complete analysis done for 84 patients. 
      In this study, two-third of patients with positive treadmill test were with significant lesions which more significant in gender, high BMI, and smoking and residual one third with the normal result or no significant lesion. In this study, there is no association between ST depression and culprit lesion in angiography except in complex coronary diseases which give an extensive ST depression in stress time.
In this study, there is a significant association between high-risk duke treadmill test and the extent of coronary artery disease (p < 0.0001) and a significant relation between duke treadmill score and syntax score (p 0.0001).