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

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.