Önder KAYA, Ramazan ASLAN, Fatma Nihan TURHAN ÇAĞLAR
Cardiovascular Surgery and Interventions - 2026;13(2):77-83
Objectives: The aim of this study was to investigate the value of non-invasive parameters, including heart rate recovery (HRR), QT dispersion (QTd) and the Duke treadmill score (DTS), in predicting the presence and severity of coronary artery disease (CAD) as quantified by the Gensini score. Patients and methods: In this prospective observational study, 200 patients with stable angina pectoris and positive exercise stress tests were enrolled. All participants underwent coronary angiography (CAG). Patients were categorized into three groups based on CAG results: Normal coronary arteries (27%), non-critical CAD (47%), and critical CAD (26%). Electrocardiogram markers (QTd) and exercise parameters (HRR1, HRR2, DTS, and rate-pressure product) were analyzed in relation to the Gensini score. Results: Significant differences were observed among the three groups in QTd, HRR1, HRR2, and DTS (p<0.001). The critical CAD group exhibited the highest QTd and the lowest HRR and DTS values. Correlation analyses revealed that the Gensini score was strongly associated with QTd (r=0.742) and negatively associated with HRR1 (r=-0.672) and DTS (r=-0.632) (p<0.001). Receiver operating characteristic analysis identified QTd >32 ms (area under the curve [AUC]: 0.842) and HRR1 <11 bpm (AUC: 0.815) as significant predictors of critical stenosis, outperforming traditional markers. Multivariate logistic regression analysis identified QTd (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.04-1.14, p=0.002), HRR1 (OR: 0.82, 95% CI: 0.75-0.90, p=0.001), and Duke score (OR: 0.88, 95% CI: 0.81-0.96, p=0.015) as independent predictors of critical CAD. Conclusion: QTd and HRR1 are robust, non-invasive indicators of the presence and anatomical severity of CAD. Integrating these parameters into routine clinical evaluation can improve risk stratification and the early identification of patients requiring invasive intervention.
