Contribution of stress echocardiography to clinical decision making in unselected ambulatory patients with known or suspected coronary artery disease.
BACKGROUND
Due to its higher diagnostic accuracy stress echocardiography (SE) has been advocated as a substitute for stress ECG to detect coronary heart disease (CAD). However, its contribution to clinical decision-making in unselected patients presenting to the ambulatory care centre for known or suspected coronary artery disease is unclear.


METHODS
To evaluate the clinical value of SE in unselected patients, we prospectively obtained SE and stress ECG in 221 consecutive patients (142 males; mean age 58+/-12 years) presenting to the ambulatory care centre with known or suspected CAD. Patients with acute coronary syndrome were not included.


RESULTS
Results of stress ECG and SE were concordant in 181 (82%) and discordant in 40 patients (18%). The clinical decision to recommend or to currently withhold coronary angiography was possible solely on the basis of clinical criteria and stress ECG findings in 191 (86.4%) patients but was guided by the results of SE in 30 patients (13.6%). Left heart catheterization and coronary angiography were conducted in 61 patients. In this population SE was more accurate (82.6%) than stress ECG (65.6%) in indicating significant coronary artery stenosis.


CONCLUSIONS
Despite its higher accuracy, SE adds little to the information derived from dynamic stress ECG and symptom evaluation in unselected outpatients with known or suspected CAD. Thus, SE should not in general replace stress ECG as a screening method for detecting significant coronary artery disease, for both clinical and economic reasons.
Department of Cardiology, Internal Medicine III, University Hospital, Bergheimer Strasse 58, D-69115 Heidelberg, Germany. ekkehard_gruenig@med.uni-heidelberg.de
Ekkehard
E
Grünig
Derliz
D
Mereles
Andreas
A
Benz
Alexander
A
Hansen
Wolfgang
W
Kübler
Helmut
H
Kuecherer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003657:Decision Making; D025401:Echocardiography, Stress; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005189:False Positive Reactions; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity