title: Utility and limitation of treadmill exercise echocardiography for detecting significant coronary stenosis in infarct-related arteries in patients with healed myocardial infarction.
abstract: This clinical study examines the diagnostic accuracy of exercise echocardiography for detecting significant coronary stenoses in infarct-related arteries in patients with healed myocardial infarction. Quantitative coronary angiography and exercise echocardiography using treadmill testing were performed within 2 weeks of each other in 123 patients with a prior myocardial infarction. Coronary lumen diameter stenosis > or =50% by quantitative coronary angiography and the lack of a hyperdynamic response on exercise echocardiography was considered significant. For detection of infarct-related coronary lesions, treadmill exercise echocardiography was highly sensitive (91%) but less specific (59%) than for detection of non-infarct-related artery lesions. The 2 groups of patients with large and small infarct sites had similar sensitivity for detection of residual stenosis of the infarct-related artery (88% vs 96%, p = NS); however, the specificity of the small infarct sites for this purpose was significantly higher than that of the large infarct sites (86% vs 33%, p < 0.01). When remote ischemia was detected on exercise echocardiography, the specificity of exercise echocardiography was significantly lower (33% vs 70%, p < 0.05) than when remote ischemia was not present. Thus, although there is high sensitivity, the specificity of treadmill exercise echocardiography for detecting infarct-related artery lesions is limited. However, high specificity is maintained when the infarct size is small and/or remote ischemia is not present.
authors.affiliation: Division of Cardiology, First Department of Medicine, Self Defense Forces Central Hospital, Tokyo, Japan. tosh@tokyo.email.ne.jp
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Nishioka
authors.forename: Hideki
authors.initials: H
authors.lastname: Mitani
authors.forename: Akimi
authors.initials: A
authors.lastname: Uehata
authors.forename: Bonpei
authors.initials: B
authors.lastname: Takase
authors.forename: Kazushige
authors.initials: K
authors.lastname: Isojima
authors.forename: Tomoo
authors.initials: T
authors.lastname: Nagai
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Ohsuzu
authors.forename: Akira
authors.initials: A
authors.lastname: Kurita
authors.forename: Shingo
authors.initials: S
authors.lastname: Ohtomi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology; D012307:Risk Factors; D012680:Sensitivity and Specificity