Cold pressor test during two-dimensional echocardiography: usefulness in detection of patients with coronary disease

We assessed the feasibility and value of the cold pressor test (CPT) during real-time two-dimensional echocardiography (2DE) in patients with suspected coronary artery disease and normal resting left ventricular wall motion. Twenty patients were studied without knowledge of angiographic findings that demonstrated no significant coronary artery disease in seven (group 1) and significant coronary lesions in 13 (group 2). The increments in physiologic parameters (heart rate, systolic blood pressure, and double product) were not significantly different in both groups. CPT-induced wall motion abnormalities were identified echocardiographically in nine patients in group 2 and in one patient in group 1 (sensitivity 69% and specificity 86%). None of the patients in our study developed chest pain, ST changes, or ectopy during the test. It is concluded that 2DE combined with the CPT is valuable in identifying patients with coronary artery disease who show no left ventricular asynergy at rest.