Diagnostic Performance of the Master Double 2-Step Exercise Electrocardiogram for Detecting Coronary Microvascular Dysfunction in Patients Without Obstructive Coronary Artery Disease

Abstract

Background: The diagnostic utility of the exercise electrocardiogram (ECG) in detecting coronary microvascular dysfunction (CMD) remains unclear.

Methods and Results: We analyzed 101 patients without obstructive coronary artery disease (CAD) who underwent the Master double 2-step exercise ECG and invasive coronary physiological assessment. The sensitivity, specificity, positive predictive value, and negative predictive value of ischemic ECG changes for detecting CMD were 0.44, 0.97, 0.85, and 0.84, respectively. The post-test probability of CMD increased from 24.8% to 82.8% with a positive ECG finding.

Conclusions: The Master double 2-step exercise ECG demonstrated high specificity for detecting CMD in patients without obstructive CAD.