Exercise cross-sectional echocardiographic diagnosis of coronary artery disease.
To test the feasibility of detecting transient left ventricular regional wall motion abnormalities during exercise-induced myocardial ischemia, 55 patients undergoing diagnostic coronary arteriography were studied in a prospective blinded manner with wide angle cross-sectional echocardiography. The ultrasonic studies were obtained with the patients at rest and during exercise in the supine position using a bicycle ergometer. Cross-sectional echocardiographic studies during exercise were adequate for analysis in 43 (78 percent) of the 55 patients. Forty-one of the 43 manifested either a new regional wall motion abnormality during exercise (20 subjects) or wall motion that remained entirely normal during exercise (21 subjects); in two subjects an abnormal wall motion abnormality at rest did not change with exercise. Nineteen of the 20 patients with a new regional wall motion abnormality had significant coronary artery disease and 15 of these 19 had S-T segment depression during bicycle ergometry. The one patient with a normal coronary arteriogram had an early cardiomyopathy. Ten of the 21 subjects with normal wall motion at rest and during exercise had a normal coronary arteriogram, whereas 11 had evidence of important anatomic coronary artery disease and thus had a false negative echocardiographic findings. Six of these 11 patients had S-T segment depression during exercise. The usefulness of exercise echocardiography to predict coronary artery disease was not altered even when only 26 patients without previous myocardial infarction and with a normal cross-sectional echocardiogram at rest were considered. Thus, new regional wall motion abnormalities during exercise as identified with cross-sectional echocardiography represent a specific finding for the presence of coronary artery disease. However, normal regional wall motion during exercise does not exclude the presence of important anatomic coronary artery disease.
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis*; D004452:Echocardiography; D005080:Exercise Test; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000150:complications