Evaluation of the Benefit of Exercise Testing for the Diagnosis of Obstruction in the Coronary Arteries of the Heart

Study Overview
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Brief Summary
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The purpose of this study is to determine whether exercise testing can detect an obstruction in a coronary artery, and, thereby, can avoid performing a coronary imaging in some cases. Patients with a suspicion of coronary artery disease perform an exercise test on an exercise bike with increasing load. EKG, blood pressure, and other parameters are monitored. Patients benefit also of either a cardiac CT scan or a coronary angiography to establish whether they really have coronary obstruction.

Detailed Description
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Double product DP (product of systolic blood pressure and heart rate) is directly related to the myocardial oxygen consumption (MVO2). Since O2 extraction by the myocyte in maximal at rest, only an increase in coronary blood flow can increase MVO2 during exercise. Therefore, if a coronary stenosis limits the maximal coronary flow, it will limit MVO2 and DP at exercise. Patients with both an exercise test and a coronary artery imaging (cardiac CT or coronary angiography) within 3 months, are included. DP increase (DP max/DP at rest) is measured during a maximal, symptom-limited exercise on a cycloergometer. DP at rest is measured either before the exercise test, at the end of the recovery period or during a visit to the cardiologist in the 2 months of the test, whichever is the smallest. The predictive power to detect a significant coronary artery stenosis is assessed by computing a Receiving Operating Characteristic (ROC) curve, its area under the curve, sensitivity, specificity, and decision thresholds. Number expected: 100-120 Time period of data collection: 1/1/2019 to 3/1/2022

Official Title
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Evaluation of the Predictive Power of Double-product Increase Measured During an Exercise Test for the Prediction of Coronary Stenosis as Diagnosed by Cardiac CT Scan or Coronary Angiography.

Conditions
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Coronary Artery Disease

Intervention / Treatment
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* Diagnostic Test: Exercise test
* Diagnostic Test: Cardiac CT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Starting betweew 1/1/2019 and 3/1/2022 18 year-old patients or older Patients with both exercise testing and either Cardiac CT or coronary angiography within 3 months Patients informed and not opposing to their participation to the study Exclusion Criteria: Patients unable to fully understand the information related to the study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Exercise test|exercise test on an exercise bike with increasing load|
|Diagnostic Test: Cardiac CT|cardiac CT scan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Area Under the ROC curve | AUC of the ROC curve defined by DP increase and significant coronary artery stenosis or not | at 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Youden threshold | Maximalization of the difference between sensitivity and 1-specificity | at 3 months | 
| ROC for women | AUC for women | at 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exercise testing, coronary stenosis, double product