Coronary CT In Asymptomatic Subjects With VentricularRepolarization Abnormalities During Maximal Exercise Test

ABSTRACT: Specific data are still lacking about the significance of repolarization abnormalities observed during exercise test in physically active asymptomatic subjects. Coronary CT is a highly sensitive diagnostic procedure able to confirm or exclude a significant coronary artery disease (CAD). PUR POSE : To evaluate if the occurrence in asymptomatic subjects of ECG repolarization abnormalities potentially suggesting a CAD, is confirmed by coronary CT. Further, clarify if the likelihood of detecting CAD or coronary anomalies was related to the degree of the ECG abnormalities and to the prevalence of cardiovascular risk factors. MET HODS: Among 940 athletes performing a maximal exercise test for sport eligibility (age 30-60yrs), 44 asymptomatic subjects (4,7%, 39 men and 5 females, 45,2±7,1yrs) demonstrated repolarization abnormalities requiring the completion of a coronary CT. The exercise tests were classified into two categories: suspicious and positive for CAD.RESU LTS : The average maximal heart rate at exhaustion was 170,4±11,9. Risk factors evaluation demonstrated 10 subjects with hypertension, 23 subjects with hypercholesterolemia, 5 smokers. Among the 44 subjects 23 had a suspicious while 21 had a positive exercise test. The coronary CT demonstrated 6 subjects (13,6%) with a clinically significant CAD, 8 non-significant CAD, while 7 showed various coronary abnormalities. Considering the coronary CT as “gold standard”, the positive predictive value (PPV) of the exercise test for any coronary anomaly was 61,9% for positive exercise tests (47,7% including suspicious tests), while the PPV of positive tests for CAD was 47,6% (31,8% including suspicious tests). The association of late recovery abnormalities and cardiovascular risk factors improved the likelihood of CAD. CON CLUSION : Our data suggest the clinical importance of slight repolarization abnormalities occurring at the peak of the exercise in asymptomatic middle-aged athletes, particularly when associated with the presence of cardiovascular risk factors. They also support the importance of a prolonged ECG monitoring during the late recovery phase. The PPV of a maximal exercise test in asymptomatic athletes appears lower than what observed in symptomatic subjects, however, about half of these subjects demonstrated some coronary anomalies.