title: Usefulness of immediate postexercise two-dimensional echocardiography in post-myocardial infarction patients without ischemic ECG changes in stress testing: comparison with radionuclide angiography.
abstract: Of 38 post-myocardial infarction (MI) applicants for a cardiac rehabilitation program, 17 (45%) did not have ischemic ECG changes in exercise testing. Ten (59%) of these 17 patients had echocardiographic wall motion abnormalities at rest. Immediate postexercise two-dimensional echocardiography demonstrated exercise-induced changes in 8 (47%) patients (2 with normal and 6 with abnormal results from rest studies). The comparative radionuclide (RNA) examinations showed that there were 6 patients with abnormal findings from rest RNA; exercise-induced changes were detected in 7 (44%) of 16 patients (3 with normal and 4 with abnormal results from rest RNA tests). Statistical analyses, using RNA as reference point, revealed that the total correctly diagnosed cases for the echocardiographic rest studies was 13/17 (77%) and for the exercise studies, 13/16 (81%). The negative predictive values were 7/7 (100%) and 7/8 (88%), respectively. The corresponding positive predictive values were 6/10 (60%) and 6/8 (75%). The same pattern was observed when each segment (septal, apical, and posterolateral) was evaluated separately. The authors conclude that in post-MI patients with a negative stress test, the efficacy of postexercise echocardiography equals that of RNA in the identification of additional patients with ischemia.
authors.affiliation: Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Pines
authors.forename: E Z
authors.initials: EZ
authors.lastname: Fisman
authors.forename: E
authors.initials: E
authors.lastname: Ben-Ari
authors.forename: M
authors.initials: M
authors.lastname: Modan
authors.forename: G
authors.initials: G
authors.lastname: Kessler
authors.forename: Y
authors.initials: Y
authors.lastname: Drory
authors.forename: J J
authors.initials: JJ
authors.lastname: Kellermann
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000175:diagnosis; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011875:Radionuclide Angiography