Arm exercise testing for coronary artery disease in patients with peripheral vascular disease

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Abstract
We evaluated 74 peripheral vascular disease (PVD) patients (54 men, age 61 ± 7 years and 17 women, age 63 ± 7 years) for potential coronary heart disease (CAD) using an arm exercise test (AET) protocol. All patients performed upright two-arm cranking using discontinuous stages of 2 minutes of exercise separated by 2 minutes of rest. Exercise intensity was increased by + 100 or 200 kpm (kilopond meters) with each stage. ECG was monitored continuously and blood pressure and 12-lead ECG tracings were obtained at the end of each exercise stage. All patients reached an endpoint of subjective exhaustion. Men achieved 91 ± 14% of age-predicted heart rate at 597 ± 167 kpm, while women achieved 86 + 14% of age-predicted heart rate at 335 ± 117 kpm. Ischemic ECG responses (+AET) defined as new or additional ST depression > 1.0 mm × 80 ms, occurred in 35 men (65%) and 7 women (42%). Coronary angiography was performed in a subset of 22 patients (15 males and 7 females). CAD (>70% stenosis) was found in 11 of 12 men and 4 of 5 women who showed positive or strongly positive AET responses (overall predictive value for AET = 88%). We conclude that arm exercise stress testing is safely performed in PVD patients who cannot complete treadmill exercise. In this limited series of PVD patients, the predictive value of a + AET response for diagnosis of CAD is similar to established values for treadmill exercise.