Risk stratification for restenosis after coronary angioplasty by means of exercise echocardiography.
To assess the prognostic contribution of exercise two-dimensional echocardiography in patients undergoing elective coronary angioplasty, 60 patients (44 males, 16 females, mean age 61 years) were enrolled in this study. The series included 31 patients with single-vessel disease, 23 with two vessel, and 5 with three vessel disease. After successful PTCA, they underwent stress echocardiographic testing either by treadmill (n = 23) or bicycle ergometry (n = 37), performed with digital continuous loop technique. A wall motion index (WMI) was calculated at rest and at peak stress. According to WMI values, the study population was divided into three groups: patients with normal WMI both at rest and stress (Group 1); patients with abnormal baseline WMI without change at stress (Group 2) and abnormal WMI diagnostic of stress-induced ischemia (Group 3). During the follow-up period, minimum of 1 year, 21 patients complaining of recurrent angina or chest discomfort, had repeat angiography: in 13 of these, typical restenosis of a previously dilated artery was found; 2 patients had progression of atherosclerotic plaque and in 6 the angiogram showed a good result of PTCA. Thirteen patients with restenosis or progressive disease underwent repeat PTCA. In this group, only 2 belonged to Group 1, 4 to Group 2, and 7 to Group 3. Thus, a linear correlation between the WMI value post-angioplasty and the clinical course could be documented (p = 0.001). Stress echocardiography was superior to stress ECG in both negative predictive value (88 and 77% respectively) and positive predictive value (73 versus 50%).(ABSTRACT TRUNCATED AT 250 WORDS)
Gentile
R
R
Clinica Medica Generale III, Università degli Studi La Sapienza, Roma.
Dillon
J
J
Ryan
T
T
Feigenbaum
H
H
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy; D004452:Echocardiography; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment; D012680:Sensitivity and Specificity