Étude comparative de l’ischémie d’effort entre patients coronariens et patients atteints de rétrécissement aortique

Abstract

Objective To compare exercise and recovery data between a population of patients with proven CAD and patients with pure aortic stenosis (AS). Patients and methods Exercise testing results (bicycle ergometry) of 45 patients with AS (34 men, 66 ± 12 years, 56 ± 20 mmHg peak-to-peak gradient and valve area 0.78 ± 0.48 cm 2) were compared to exercise testing results of 50 patients with CAD (41 men, 65 ± 9 years, greater or equal to 70% stenosis on one vessel in 62%, two vessels in 30%, three vessels in 8%). Results During exercise, 38% patients with AS and 82% patients with CAD had clinical symptoms. In the AS group, exercise duration was longer, heart rate (HR) was higher, maximal systolic and diastolic blood pressure were lower than in CAD group. The increase of systolic blood pressure was lower in the AS group (34 ± 21 mmHg versus 47 ± 27 mmHg, p < 0.02). Maximal load achieved was not significantly different. Exercise ST depression appeared in 76% of AS group and 88% of CAD group (NS). No difference was found in ST depression, Detrano index and ST segment/HR slope. During recovery, no difference was found in HR variations. Clockwise rotation of the ST/HR recovery loop was more frequent in CAD group (35 patients versus 19 patients, p < 0.001). Conclusion Most of the exercise and recovery data are similar in patients with AS and CAD. Significant discriminating criteria were the increase of systolic blood pressure during exercise and ST/HR recovery loop.