title: Comparison of treadmill exercise echocardiography before and after exercise in the evaluation of patients with known or suspected coronary artery disease.
abstract: OBJECTIVE
  We sought to compare the feasibility and accuracy of peak treadmill exercise echocardiography versus postexercise echocardiography imaging.
  
  
  BACKGROUND
  Although peak exercise echocardiography has been reported for both supine and orthostatic bicycle exercise and has shown higher sensitivity than postexercise imaging, acquiring images at peak exercise with treadmill has not been explored.
  
  
  METHODS
  Peak and post-treadmill exercise echocardiography and coronary angiography were performed on 89 patients with known or suspected coronary artery disease. Positive exercise echocardiography was defined as necrosis or ischemic response. Positive coronary angiography was defined as >/=1 diseased vessels (>/=50% luminal narrowing). Images were analyzed in a blind manner by an expert observer.
  
  
  RESULTS
  Postexercise images were acquired within 80 seconds after exercise (40 +/- 14). Mean heart rate (bpm) was 139 +/- 22 at peak versus 118 +/- 25 at postexercise imaging (P <.001). Interpretable peak and postexercise images were obtained for all 89 patients. Of the 72 classified as having positive exercise echocardiography, 23 had new regional wall motion abnormality at peak (21 with positive angiography), which resolved at postexercise imaging. Sensitivity was higher with peak than with postexercise imaging (94% vs 73%, P <.001). Specificity was similar (68% vs 79%), as was predictive positive value (92% vs 93%). Negative predictive value was again higher with peak imaging (76% vs 44%, P <.05). Total accuracy was higher with peak imaging (89% vs 74%, P <.05).
  
  
  CONCLUSIONS
  Peak treadmill exercise echocardiography is technically feasible and has higher sensitivity and accuracy than post-treadmill exercise echocardiography. Therefore in the clinical setting peak exercise echocardiography should be performed to diagnose ischemia.
authors.affiliation: Unit of Echocardiography and Department of Cardiology, Juan Canalejo Hospital, A Coruña, Spain. jpeteiro@pulso.com
authors.forename: J
authors.initials: J
authors.lastname: Peteiro
authors.forename: R
authors.initials: R
authors.lastname: Fabregas
authors.forename: L
authors.initials: L
authors.lastname: Montserrat
authors.forename: N
authors.initials: N
authors.lastname: Alvarez
authors.forename: A
authors.initials: A
authors.lastname: Castro-Beiras
mesh_terms: D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D015444:Exercise; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015588:Observer Variation; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013318:Stroke Volume