The role of cervical lordosis angle in the differential diagnosis of chest pain after Exercise electrocardiography test

Year 2025, Volume: 16 Issue: 56, 168 - 174, 16.12.2025

Emre Melik Faideci , Zeynep Dağlar , Sinan Güzel , Mustafa Bestami Maraşlı , Tolga Türkmen , Mehmet Dokur , Murat Ziyrek

https://doi.org/10.17944/interdiscip.1708493

Abstract

Objectives: The exercise electrocardiography test (EET) is extensively utilized for diagnosing stable angina pectoris (SAP). Nonetheless, differential diagnosis may prove difficult in instances of chest discomfort absent ischemic indicators. The loss of cervical lordosis (LCL) and several cervical diseases may be implicated in non-cardiac chest discomfort.
Methods: This retrospective study evaluated 216 patients who experienced chest pain during EET without ischemic ECG changes and underwent invasive coronary angiography (ICA) and cervical spine radiography (CSR). Among them, 18 patients with significant cervical pathologies apart from LCL were excluded from angle measurements. Cervical lordosis angle (CLA) was measured only in patients without additional cervical pathology.
Results: CLA was significantly lower in the CAD (–) group compared to the CAD (+) group (13.97° ± 8.82 vs. 29.20° ± 7.58; p<0.001). An increase in CLA independently predicted the presence of CAD (OR: 1.197; 95% CI: 1.135–1.264; p<0.001). Using a cut-off value of 20.5°, CAD could be predicted with 78.3% sensitivity and 79.6% specificity (AUC: 0.892). However, a decrease in CLA was insufficient to exclude cardiac etiology in chest pain.
Conclusion: The measurement of CLA post-cervical spine assessment may facilitate clinical decision-making in the differential diagnosis of chest pain subsequent to EET and assist in directing secondary testing procedures.

Keywords

Cardiac chest pain , cervical lordosis , chest pain , exercise electrocardiography , stable angina pectoris

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