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[Stress echocardiography as a routine examination in coronary heart disease]
K Schröder1, H Völler, B Hansen
1Abteilung für Innere Medizin mit Schwerpunkt Kardiologie und Pulmologie, Medizinische Klinik und Poliklinik, Klinikum Steglitz der Freien Universität Berlin.
Insights
Stress echocardiography is a valuable tool for diagnosing coronary heart disease, showing higher sensitivity and specificity than exercise electrocardiography. This method effectively identifies significant coronary artery stenoses in patients with suspected angina.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary heart disease (CHD) diagnosis relies on various methods, including exercise electrocardiography.
- Stress echocardiography offers a non-invasive approach to assess cardiac function under stress.
Purpose of the Study:
- To evaluate the efficacy of stress echocardiography in the routine diagnosis of CHD.
- To compare stress echocardiography with exercise electrocardiography in patients with suspected angina.
Main Methods:
- 100 patients with suspected angina underwent stress echocardiography using bicycle ergometry, transesophageal atrial stimulation, dipyridamole, or dobutamine infusions.
- Exercise electrocardiography was also performed for comparison.
- Semiquantitative wall motion analysis was employed.
Main Results:
- Stress echocardiography was successfully performed in 91 patients, exceeding the success rate of exercise electrocardiography (78 patients).
- Stress echocardiography demonstrated superior sensitivity (90% vs. 78%) and specificity (90% vs. 73%) compared to exercise electrocardiography.
- Wall motion analysis effectively differentiated between patients with and without functionally significant coronary artery stenoses (P < 0.001).
Conclusions:
- Stress echocardiography is a highly effective diagnostic tool for identifying or excluding functionally significant coronary artery stenoses.
- It offers improved diagnostic accuracy over traditional exercise electrocardiography for CHD assessment.
Abstract:
The value of stress echocardiography in the routine diagnosis of coronary heart disease was assessed in 100 consecutive patients (22 women, 78 men; mean age 57 [32-83] years) scheduled for coronary angiography because of suspected angina. Exercise consisted of bicycle ergometry (n = 50), on the one hand, simulated exercise with transoesophageal atrial stimulation (n = 16), dipyridamole (n = 33) and dobutamine (n = 33) infusions, on the other. 91 patients were successfully tested by at least one of these procedures, while exercise electrocardiography was successfully employed in only 78 (P < 0.05). Stress echocardiography had a greater sensitivity than exercise electrocardiography (90% vs 78%) and specificity (90% vs 73%). Semiquantitative measurement of wall movement distinguished patients without functionally effective stenosis from those with single or multiple vessel disease (P < 0.001). Stress echocardiography thus makes it possible in most cases to demonstrate or exclude functionally significant coronary artery stenoses.