Circulation, Vol 67, 1211-1218, Copyright © 1983 by American Heart Association
MC Limacher, MA Quinones, LR Poliner, JG Nelson, WL Winters Jr and AD Waggoner
Two-dimensional echocardiography (2-D echo) was performed in 73 patients
evaluated for coronary artery disease (CAD) and in four normal volunteers
before and immediately after a maximal treadmill exercise test. Diagnostic
images were obtained from the apical and parasternal windows. In 17
patients with normal coronary arteriograms, ejection fraction (EF)
increased from 66 +/- 9% (+/- SD) at rest to 73 +/- 8% after exercise (p
less than 0.001), while in 56 patients with proved CAD, EF fell from 56 +/-
13% at rest to 53 +/- 16% after exercise (p less than 0.01). The
sensitivity of postexercise 2-D echo for detecting CAD (based on abnormal
EF response and/or regional dyssynergy) was 91% (51 of 56 patients) and the
specificity was 88% (15 of 17). Sensitivity for one-, two- and three-vessel
disease was 64% (seven of 11), 95% (20 of 21) and 100%, respectively.
Patients with multivessel disease showed a significant fall in a wall
motion score index, from 0.79 +/- 0.25 to 0.63 +/- 0.26. Exercise
radionuclide ventriculography (RNV) was also performed in 41 of the
subjects (17 normals and 24 CAD patients) on a bicycle ergometer. The
overall sensitivity of 2-D echo in this subgroup was 92%, compared with 71%
for RNV. The sensitivity of 2-D echo for one- vessel disease (n = 4) was
50%, that for two-vessel disease (n = 12) was 100% and that for
three-vessel disease (n = 12) was 100%. Respective values for RNV were 0%,
80% and 90%. The specificity of 2-D echo was 88% and that of RNV was 82%. A
significantly higher peak heart rate response was observed on the treadmill
than on the bicycle ergometer in both CAD patients and normal subjects. We
conclude that postexercise 2-D echo is a clinically applicable technique
for the diagnosis and evaluation of CAD patients and compares favorably
with exercise RNV.
ARTICLES
Detection of coronary artery disease with exercise two-dimensional echocardiography. Description of a clinically applicable method and comparison with radionuclide ventriculography
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