Stable angina and ST-segment depression: diagnostic value in patients undergoing coronary angiography.

BACKGROUND: Clinical history and exercise testing (ET) are the main methods used to screen for coronary artery disease (CAD). Correct interpretation of such data is essential in determining diagnostic and treatment strategies. OBJECTIVE: To assess the diagnostic value of stable angina (SA) and ET in patients with suspected CAD undergoing coronary angiography and to compare results between the sexes. METHODS: We assessed 62 patients undergoing coronary angiography; ET was performed in 54 of them, being considered positive for ischemia in cases of ST-segment depression of > or =1 mm. The coronary angiograms were analyzed by two observers and patients were divided into two groups depending on the severity of CAD: Group 1: > or =70% stenosis (n=26), and Group 2: <70% stenosis (n=36). RESULTS: The patients' mean age was 58+/-9 years, and 55% were male. SA was found in 24% of cases and ET was positive for ischemia in 53%. SA showed a sensitivity of 46.1%, specificity 91.7%, positive predictive value (PPV) 80%, negative predictive value (NPV) 70%, positive likelihood ratio (LR+) 5.1 and negative likelihood ratio (LR-) 0.6, while the corresponding results for ET were sensitivity of 70.8%, specificity 60%, PPV 59%, NPV 72%, LR+ 1.75 and LR- 0.5. SA was shown to have a greater NPV in women, and the LR+ was also significantly higher in women. CONCLUSION: SA was shown to be a good diagnostic marker, with high specificity and PPV. The greater NPV and LR+ in women was shown to be superior for post-test prediction of angina. ET results were similar for both sexes and showed similar sensitivity and specificity to that reported in the literature.

[Carotid intimal-medial thickening and endothelial function in coronary artery disease]. / Espessamento médio-intimal da carótida e função endotelial na doença arterial coronariana.

OBJECTIVE: To investigate the correlation between the endothelial function and the carotid intimal-medial thickening (IMT) in a population of patients with coronary artery disease, as well as that between the endothelial function and carotid IMT with the severity of the coronary lesions. METHODS: Forty-three patients aged 60.5+/-9.2 years, (67.4% males) with coronary artery disease at the coronariography were studied. Endothelial function was assessed using the brachial artery reactivity test (BART), which measured the percentage of flow-mediated dilatation (%FMD). The carotid IMT was evaluated through vascular ultrasound. RESULTS: The mean %FDM was 4.7 +/- 3.6 and the mean carotid IMT was 1.08 +/- 0.23 mm. The carotid MIT and %FMD measurements showed a statistically significant correlation, with Spearmans coefficient of 0.315, p= 0.042, demonstrating that lower %FMD values corresponded to an increased carotid IMT (r = -0.315, p = 0.042). There was no correlation between %FMD or IMT and the severity of coronary lesions. CONCLUSIONS: The presence of a correlation between carotid IMT and %FMD demonstrates a concomitance of anatomical and functional vascular alterations in coronary artery disease, regardless of the severity of the atherosclerotic lesions.

Espessamento médio-intimal da carótida e função endotelial na doença arterial coronariana / Carotid intimal-medial thickening and endothelial function in coronary artery disease

OBJETIVO: Investigar uma correlação entre o teste de reatividade da artéria braquial (BART) e o espessamento médio-intimal (EMI) da carótida em uma população de pacientes com doença arterial coronariana, assim como avaliar uma correlação do BART e do EMI da carótida com a gravidade da doença arterial coronariana demonstrada através da coronariografia. MÉTODOS: Quarenta e dois pacientes (idade: 60,7 ± 9,2 anos, 66,7 por cento do sexo masculino) com doença arterial coronariana por coronariografia foram estudados. A função endotelial foi avaliada de modo não-invasivo através do BART, quando foi medido o porcentual de dilatação mediada pelo fluxo ( por centoDMF). O EMI de carótida foi avaliado por meio de ultra-som vascular. RESULTADOS: A média de por centoDMF foi de 4,7 ± 3,6 e a média de EMI de carótida foi de 1,08 ± 0,23 mm. As medidas do EMI de carótida e do por centoDMF apresentaram correlação estatisticamente significativa, com coeficiente de Spearman de -0,315, valor p = 0,042, demonstrando que valores menores de por centoDMF se correlacionaram a um maior EMI de carótida. Não houve correlação entre por centoDMF, EMI e a gravidade das lesões; CONCLUSÃO: A presença de uma correlação entre o por centoDMF e o EMI da carótida demonstra a concomitância de alterações vasculares funcionais e anatômicas na doença arterial coronariana, independentemente da gravidade das lesões ateroscleróticas.