The Applications And Prognostic Significance Of The Treadmill Exercise Test Performance On Coronary Heart Disease Before Thoracic Surgery

Objective:A retrospective study of the applications and prognostic significance of the treadmill exercise test performance on coronary heart disease before thoracic surgeryMethods:To select336cases of inpatients from January2009to October2013in general thoracic surgery of the Second Xiangya Hospital of Central South University. Their treadmill exercise test(TET) was positive or suspected positive, and they were underwent with coronary angiography(CAG) in a week, all of them had a complete clinical data. Coronary angiography was the gold standard in the diagnosis of coronary heart disease (CHD). Firstly, compared the group of positive treadmill exercise test with the group of suspicious positive treadmill exercise test on positive predictive value for coronary heart disease. Secondly, contrast all the cases by age, sex, hypertension, diabetes, general thoracic diseases, examined their effects on positive predictive value of coronary heart disease. Finally, observed the value of treadmill exercise test as a preoperative examination in general thoracic surgery by analysis of the next treatment of all cases.Results:There were252male patients (75%) and84female patients(25%) in336patients, their age ranged from37to85years old, average age was59.77±7.92years old. The positive predictive value of TET for CHD was28.27%. The positive predictive value of positive TET and suspicious positive TET for CHD were36.36%and23.04%, the difference was statistically significant(P<0.05). The positive predictive value of older group (aged≥60years old) and middle-aged group (age <60years) of TET for CHD were40.35%and15.76%, and the difference was statistically significant(P<0.05). The positive predictive value of male group and female group of TET for CHD were31.35%and19.05%, and the difference was statistically significant(P<0.05). The positive predictive value of hypertension group and non-hypertension group of TET for CHD were57.69%and22.89%, and the difference was statistically significant.(P<0.05) The positive predictive value of diabetic group and non-diabetic group of TET for CHD were62.07%and25.08%, and the difference was statistically significant(P<0.05). The positive predictive value of lung disease group, esophageal disease group and mediastinal disease group of TET for CHD were30.04%,23.08%and22.58%, and the difference was not statistically significant(P>0.05).241 cases of patients without CHD unused medication on coronary heart disease. Patients with mild or moderate coronary artery stenosis had used medication on coronary heart disease. There were28cases of Patients with severe coronary artery stenosis,15cases of them finally had received an operation,6cases of them had received only general thoracic surgery,3cases of them concomitant had received Percutaneous Coronary Intervention(PCI) and general thoracic surgery,6cases of them concomitant had received coronary artery bypass graft surgery(CABG) and general thoracic surgery, one case of patients which had received CABG and general thoracic surgery died after surgery. All of patients with severe coronary artery stenosis had received medication on coronary heart disease.Conclusion:1. Treadmill exercise test as a noninvasive examination before thoracic surgery has a predictive value for coronary heart disease, and it can be used to assess perioperative risk and provide the basis for perioperative management.2. The predictive value of TET for CHD is not associated with the types of thoracic surgical diseases, but with age, gender, hypertension and diabetes.