title: [Stress echocardiography in the identification of left anterior descending coronary artery disease in patients with inferior myocardial infarction and a positive exercise electrocardiography result].
abstract: 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.
authors.affiliation: Servicio de Cardiología, Hospital Txagorritxu, Pintor Vera Fajardo 11C, 01008 Vitoria-Gasteiz, Alava, Spain. angelmago@euskalnet.net
authors.forename: Angel M
authors.initials: AM
authors.lastname: Alonso-Gómez
authors.forename: María C
authors.initials: MC
authors.lastname: Belló
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Fernández
authors.forename: Alfonso
authors.initials: A
authors.lastname: Torres
authors.forename: Maite
authors.initials: M
authors.lastname: Alfageme
authors.forename: Felipe
authors.initials: F
authors.lastname: Aizpuru
authors.forename: José
authors.initials: J
authors.lastname: Martínez-Ferrer
authors.forename: Andrés
authors.initials: A
authors.lastname: Díaz
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
mesh_terms: 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
chemical_list: D013566:Sympathomimetics; D004280:Dobutamine