Aortic Valve Sclerosis on Echocardiography is a Good Predictor of Coronary Artery Disease in Patients With an Inconclusive Treadmill Exercise Test

Background and Objectives: The treadmill exercise test (TMT) is used as a first-line test for diagnosing coronary artery disease (CAD). However, the findings of a TMT can be inconclusive, such as incomplete or equivocal re-sults. Aortic valve sclerosis (AVS) is known to be a good predictor of CAD. We determined the usefulness of as-sessing AVS on 2-dimensional (2D) echocardiography for making the diagnosis of CAD in patients with incon-clusive results on a TMT. Subjects and Methods: This prospective study involved 165 consecutive patients who underwent a TMT that resulted in inconclusive findings, 2D echocardiography to detect AVS, and coronary an-giography to detect CAD. Following echocardiography, AVS was classified as none, mild, or severe. CAD was de-fined as ≥70 % narrowing of the luminal diameter on coronary angiography. Results: CAD was more common in patients with AVS than in patients without AVS (75 % vs. 47%, respectively, p<0.01). Multiple logistic regres-sion analysis showed that AVS was the only independent predictor of CAD {odds ratio=8.576; 95 % confidence interval (CI), 3.739-19.672}. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the presence of AVS for predicting CAD in a patient with an inconclusive TMT were 62%, 67%, 64%, 75%, and 53%, respectively. During a 1-year clinical follow-up, patients with and without AVS were similar in terms of event-free survival rates. Conclusion: If the results of TMT for patients with chest pain on exertion are incon-clusive, the presence of AVS on echocardiography is a good predictor of CAD. (Korean Circ J 2009;39:275-279