[Stress echocardiography in the identification of left anterior descending coronary artery disease in patients with inferior myocardial infarction and a positive exercise electrocardiography result].
OBJECTIVE
In patients with an inferior myocardial infarction (IMI), ST-segment depression in left precordial leads during exercise electrocardiography (ExECG) has been associated with left anterior descending coronary artery (LADCA) disease. The aim of this study was to assess the value of stress echocardiography in identifying LADCA disease in patients with IMI and a highly abnormal ExECG result.


METHODS
The study included patients with an IMI and an abnormal ExECG result whose coronary angiography findings were available. A highly abnormal ExECG result was defined as ST-segment depression in three or more leads, including V5. The wall motion score index was calculated and each patient was evaluated echocardiographically for ischemia in LADCA territory.


RESULTS
Of 241 patients who underwent stress ECG, 100 (mean age 57 [11] years) met inclusion criteria. Some 38 had significant LADCA stenosis and, in 75, ExECG gave a highly abnormal result. The sensitivity, specificity and accuracy of a highly abnormal ExECG result for detecting LADCA disease were 74% (60%-88%), 26% (15%-37%), and 44% (34%-54%), respectively. Echocardiographic detection of ischemia had similar sensitivity, at 74%, but higher specificity, at 92% (P< .001), and accuracy, at 85% (P< .001). Multivariate analysis of clinical, exercise test, and stress echocardiography variables revealed that the only independent predictors of LADCA disease were age (OR=1.070), recent IMI (OR=0.136), and ischemia in LADCA territory (OR=19.9).


CONCLUSIONS
Stress echocardiography is a good noninvasive technique for detecting LADCA disease in patients with an IMI. The diagnostic accuracy of a highly abnormal ExECG result is not sufficient for its use in this clinical setting.
Alonso-Gómez
Angel M
AM
Servicio de Cardiología, Hospital Txagorritxu, Pintor Vera Fajardo 11C, 01008 Vitoria-Gasteiz, Alava, Spain. angelmago@euskalnet.net
Belló
María C
MC
Fernández
Miguel A
MA
Torres
Alfonso
A
Alfageme
Maite
M
Aizpuru
Felipe
F
Martínez-Ferrer
José
J
Díaz
Andrés
A
Arós
Fernando
F
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000175:diagnosis; D004280:Dobutamine; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018579:Patient Selection; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013566:Sympathomimetics
D013566:Sympathomimetics; D004280:Dobutamine