Exercise-provoked esophageal motility disorder in patients with recurrent chest pain

Table 1 Comparison of demographic and clinical data for 63 analyzed patients divided in relation to the presence of significant (> 50%) coronary artery narrowing and features of exercise-provoked esophageal spasm n (%)

Parameter	CAD- (n = 35)		CAD+ (n = 28)
	EPES (+) (n = 8, 23%)	EPES (-) (n = 27, 77%)	EPES(+) (n = 6, 21%)	EPES (-) (n = 22, 79%)
Male gender	2 (25)	8 (30)	3 (50)	10 (45)
Age (yr)	56.3 ± 10.0	52.9 ± 7.3	54.5 ± 11.1	54.8 ± 8.8
Body mass index (kg/m2)	31 ± 3.5	27.6 ± 4.8	30.2 ± 6.2	27.7 ± 4.0
Waist to hip ratio	0.9 ± 0.1	0.9 ± 0.1	0.9 ± 0.1	0.9 ± 0.1
> 50% narrowing of coronary vessels	0	0	6 (100)	22 (100)
Smoking	0	3 (11)	1 (16)	1 (5)
History of myocardial infarction	0	0	1 (16)	6 (27)
History of hypertension	3 (38)	10 (38)	3 (50)	8 (36)
History of diabetes (n)	1 (13)	1 (4)	2 (33)	4 (18)
Blood glucose (mg/dL)	106 ± 18.7	95.5 ± 13.7	91 ± 6.3	116.7 ± 22.2
LDL cholesterol (mg/dL)	127 ± 15.8	125.3 ± 44.2	116.6 ± 38	128 ± 34.3
Triglycerides (mg/dL)	120 ± 22	134.4 ± 58.3	154.8 ± 69.2	181.4 ± 104
Angina-like chest pain during the stress test	4 (50)	2 (15)c	4 (67)	4 (18)
Horizontal ST interval depression ≥ 1 mm	6 (75)	15 (56)	4 (75)	8 (36)
Duration of stress test (s)	477 ± 145	408 ± 158a	501 ± 186	607 ± 175
Echocardiographically determined EF (%)	60 ± 7	63 ± 3	65 ± 3	69 ± 8
Helicobacter pylori infection	4 (50)	12 (44)	2 (33)	11 (50)
Esophagitis	0	4 (15)	2 (33)	2 (9)
Pathological acid GER	0	6 (22)	2 (33)	5 (23)
Acid epGER	0	2 (7)	6 (100)	0
Calcium antagonist recommendation	8 (100)	20 (74)	6 (100)	16 (73)
Event-free period (d)	904 ± 352a	866 ± 356	887 ± 374a	541 ± 400
Hospitalization	0	10 (37)	3 (50)	11 (50)
Time to first hospitalization (d)1	494 ± 372	226 ± 124b	604 ± 335	309 ± 210

¹Calculated only for hospitalized patients.

^aP < 0.05, significance level for differences in relation to CAD+EPES- group;

^bSignificance level for differences in relation to CAD+EPES+ group;

^cIn relation to CAD-EPES+ group. CAD: Coronary artery disease; CAD-: Patients without significant coronary artery narrowing; CAD+: Patients with significant (> 50%) coronary artery narrowing; EPES: Exercise-provoked esophageal spasm; GER: Gastroesophageal reflux; epGER: Exercise-provoked GER; IEM: Ineffective motility disorders; EF: Ejection fraction; LDL: Low-density lipoprotein.

Table 2 Comparison of manometric parameter values during the treadmill stress test and during the 24-h monitoring period in patients with and without significant (> 50%) coronary artery narrowing

Parameter	CAD- (n = 35)			CAD+ (n = 28)
	24 h	ext	P	24 h	ext	P
Contractions per minute	1.5 ± 0.8	2.7 ± 1.7	0.001	1.9 ± 1.5	2.7 ± 2.2	0.04
Peristaltic contractions (%)	64.3 ± 9.6	47.2 ± 8.4	0.001	67.7 ± 28.6	56.9 ± 18.7	0.03
Complete peristalsis (%)	43.9 ± 15.3	35.6 ± 18.5	0.140	51.9 ± 10.9	49.3 ± 26.5	0.70
Reduced peristalsis (%)	18.3 ± 13.2	16.2 ± 14.8	0.630	13.3 ± 6.3	10.1 ± 7.2	0.30
Interrupted peristalsis (%)	37.8 ± 10.8	40.1 ± 30.0	0.690	34.8 ± 8.5	36.8 ± 24.1	0.70
Simultaneous/mixed contractions (%)	35.7 ± 9.6	49.3 ± 23.8	0.010	32.3 ± 8.6	43.0 ± 18.7	0.02
Complete contractions (%)	16.6 ± 5.2	35.6 ± 28.5	0.010	14.9 ± 4.4	30.6 ± 30.1	0.03
Simultaneous contractions (%)	83.4 ± 5.3	71.1 ± 28.7	0.040	85.1 ± 4.9	69.4 ± 30.1	0.03

CAD: Coronary artery disease; CAD-: Patients without significant coronary artery narrowing; CAD+: Patients with significant (> 50%) coronary artery narrowing; 24 h: Examination within one whole day; ext: Examination during the exercise test.

Table 3 Proportional hazard Cox regression model for the number of days to first hospitalization because of suspected acute coronary syndrome (χ² = 32.38, P = 0.039)

Independent variable	β	Standard error	P
Number of hospitalizations before gastrological diagnostic performance	0.01	0.06	0.87
Spontaneous chest pain during 24-h monitoring	1.05	0.56	0.06
Eradicative treatment recommendation due to Helicobacter pylori infection	-1.36	0.62	0.03
EPES	-2.38	0.93	0.01
epGER	-0.012	1.01	0.99
Significant (> 50%) coronary vessel narrowing	1.01	0.73	0.17
History of myocardial revascularization	-0.78	0.67	0.24
DUKE score	0.03	0.06	0.62
Gender (male/female)	-1.42	0.72	0.049
Smoking	0.06	1.38	0.96
Canadian Cardiovascular Society Classification	0.74	0.76	0.33
History of myocardial infarction	0.30	0.99	0.76
Hypertension	-0.47	0.96	0.63
Diabetes mellitus	-0.22	0.80	0.78
Age	0.085	0.04	0.047
BMI	0.10	0.09	0.27
WHR	-4.69	5.07	0.35
Fasting blood glucose	-0.074	0.05	0.11
LDL cholesterol	-0.015	0.01	0.18
Triglycerides	0.005	0.04	0.277

BMI: Body mass index; WHR: Waist to hip ratio; epGER: Exercise- provoked gastroesophageal reflux; EPES: Exercise-provoked esophageal spasm; LDL: Low-density lipoprotein; DUKE score = Duration of stress test according to Bruce protocol (min) - [5 × ST interval depression (mm)] - (4 × treadmill angina index).