title: Exercise testing early after myocardial infarction: comparison with echocardiography, electrocardiographic monitoring and coronary arteriography.
abstract: BACKGROUND
  Predischarge exercise testing early after myocardial infarction is useful for risk stratification, exercise prescription, and assessment of prognosis and treatment.
  
  
  OBJECTIVE
  The objective of this study was to compare the findings of exercise testing early after myocardial infarction with those of echocardiography, electrocardiographic monitoring (24-hour Holter monitoring) and coronary angiography.
  
  
  METHODS
  We evaluated 60 cases (mean age of 51.42 +/- 9.34 years), of which 46 were males (77%). The symptom-limited maximal exercise test according to the Naughton protocol12 was performed between the sixth day of hospitalization and hospital discharge, with the patients on medication. During hospitalization, the patients underwent echocardiography, electrocardiographic monitoring and coronary angiography. The significance level was set at 0.05 (alpha = 5%).
  
  
  RESULTS
  Exercise testing had a poor performance in the detection of multivessel coronary artery disease (sensitivity, 42%; specificity, 69%). No significant differences were found when the presence of ischemia on exercise test was compared with multivessel coronary disease, complex ventricular arrhythmias on electrocardiographic monitoring, and the finding of an ejection fraction lower than 60% on echocardiography (p = 0.56), as well as with the presence of multivessel lesions, complex ventricular arrhythmias on electrocardiographic monitoring and abnormal ejection fraction on echocardiography (p = 0.36).
  
  
  CONCLUSIONS
  The presence of ischemia during exercise testing was associated with the occurrence of ventricular arrhythmias on electrocardiographic monitoring, with reduced ejection fraction on echocardiography, as well as with the presence of multivessel coronary lesions, which constitutes an indicator of a high coronary risk.
authors.affiliation: Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP - Brazil.
authors.forename: Wagner Aparecido
authors.initials: WA
authors.lastname: Leite
authors.forename: Manoel Adan
authors.initials: MA
authors.lastname: Gil
authors.forename: Valter Correia
authors.initials: VC
authors.lastname: Lima
authors.forename: Bráulio
authors.initials: B
authors.lastname: Luna Filho
authors.forename: Denise Maria
authors.initials: DM
authors.lastname: Servantes
authors.forename: Angelo Amato Vincenzo de
authors.initials: AA
authors.lastname: Paola
authors.forename: Japy Angelini
authors.initials: JA
authors.lastname: Oliveira Filho
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis; D003430:Cross-Sectional Studies; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography