Effect of Exercise Stress Testing on Peripheral Gene Expression Using Corus CAD (or ASGES) Diagnostic Test

This is a prospective, single-center study. This protocol is a pilot study to investigate the effects of "acute" exercise (by exercise stress testing; modified Bruce protocol) on peripheral gene expression (PGE) levels as measured by Corus CAD score (Age/Sex/Gene Expression score - ASGES). Subjects will have blood sampling at baseline, at peak exercise, within 30 to 60 minutes post-exercise, at 24-36 hours post-exercise. The study will be stratified by presence of CAD and gender. An equal number of subjects with known CAD and normal controls will be enrolled. Equally, an equal number of men and women will be included. A screening CBC and HgbA1c will be performed to ensure the subject meets the intended use instruction for Corus CAD (ASGES). Data collection will include presence or absence of ECG ischemia with testing, as well as heart rate and blood pressure response to exercise with other ECG and dynamic variables. There will be four blood samples taken per subject as shown in the figure below.

Inclusion criteria

• Ages 45-75 years old
• Able to perform an adequate exercise stress test
• Subjects with no known CAD and subjects with known CAD subjects

Exclusion criteria

• Known severe CAD that will be unsafe to exercise stress patient
• Current MI or high-risk acute coronary syndrome (including high-risk unstable angina
• NYHA class III or IV congestive heart failure
• Severe regurgitant or stenotic cardiac valvular lesion
• Severe left ventricular systolic dysfunction
• Active systemic infection in the preceding 2 months or chronic infection (e.g. HIV, Hepatitis B or C, Tuberculosis)**.
• Protocol-specified rheumatologic, autoimmune or hematologic conditions
• Known or suspected diabetes mellitus or documented Hemoglobin A1C (A test for people with diabetes that monitors their average blood sugar levels over a period of two to three months) percent within last 6 months; presume normal HgbA1c (used as a standard tool to determine blood sugar control for patients with diabetes.) if none documented.
• Total WBC 11,000/ul from a CBC drawn within 7 days of enrollment
• Inadequate exercise stress test.
• Recipient of any organ transplant
• Immunosuppressive or immunomodulatory therapy including any dose of systemic corticosteroids in the preceding two months
• Chemotherapy in the preceding year
• Major surgery in the preceding 2 months
• Blood or blood product transfusion in the preceding 2 months