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Echocardiographic documentation of myocardial ischemia in presence of angina pectoris without ST-T changes
Insights
Echocardiography combined with provocative testing effectively detects silent myocardial ischemia. This non-invasive method identifies mechanical changes missed by electrocardiograms, aiding diagnosis in patients with angina.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Electrocardiographically silent myocardial ischemia presents a diagnostic challenge.
- Echocardiography can detect ischemia-induced mechanical changes.
- Coronary artery disease (CAD) patients often have inconclusive electrocardiograms (ECGs).
Purpose of the Study:
- To evaluate the utility of combined electrocardiography and echocardiography with provocative testing.
- To detect electrocardiographically silent myocardial ischemia in patients with angina.
Main Methods:
- 32 patients with effort angina and 15 with rest angina underwent combined ECG and 2D echocardiography.
- Ergonovine testing was used for rest angina patients; dipyridamole testing for effort angina patients.
- Positivity was defined by regional transient asynergy on echocardiography.
Main Results:
- The Ergonovine-Echocardiographic test was positive in 40% (6/15) of rest angina patients.
- The Dipyridamole-Echocardiographic test was positive in 56% (18/32) of effort angina patients.
- Echocardiography provided objective mechanical evidence of ischemia.
Conclusions:
- Combined echocardiography and provocative testing is a practical, non-invasive tool.
- This method can unmask electrocardiographically silent myocardial ischemia.
- Feasible in patients with good basal echocardiograms, it aids in diagnosing CAD.
Abstract:
A frequent clinical problem is to document the elusive entity of electrocardiographically silent myocardial ischemia. Since echocardiography offers a practical tool to detect reversible mechanical changes due to ischemia, 32 patients with angina on effort, and coronary artery disease, and 15 patients with angina at rest were studied. In all 47 patients electrocardiographic changes during effort or rest pain were inconclusive. Combined 12 lead electrocardiographic and 2-Dimensional echocardiographic monitoring were performed: during ergonovine testing in the 15 patients with angina at rest; during dipyridamole testing in the 32 patients with effort angina and a non diagnostic stress test. Interpretable echocardiograms were obtained in all the patients studied. Positivity of both the Ergonovine-Echocardiographic test and the Dipyridamole-Echocardiographic test was based upon the detection of regional transient asynergy. Of the 15 patients who had chest pain at rest in the absence of diagnostic electrocardiographic changes, Ergonovine-Echocardiographic test was positive in 6 (40%). Of the 32 patients who had chest pain in absence of diagnostic electrocardiographic changes during exercise stress testing, the Dipyridamole-Echocardiographic test was positive in 18 (56%). Echocardiographic monitoring in combination with provocative testing (ergonovine and dipyridamole) may be a practical, non invasive, inexpensive tool which is feasible in all patients with good basal echocardiograms and is able to unmask electrocardiographically silent myocardial ischemia by providing objective mechanical evidence of the ischemic event.