[Exercise two-dimensional echocardiography: correlation between exercise induced asynergy and coronary artery...

Area of Science:

• Cardiology
• Diagnostic Imaging
• Exercise Physiology

Context:

• Coronary artery disease (CAD) diagnosis often relies on correlating symptoms with objective findings.
• Exercise stress testing is a common modality, but interpreting results requires careful consideration of various factors.
• Left ventricular asynergy, a sign of impaired heart muscle function during stress, is a key indicator.

Purpose:

• To evaluate the utility of exercise two-dimensional (2-D) echocardiography in detecting exercise-induced left ventricular asynergy.
• To compare the findings of asynergy with coronary artery stenosis and electrocardiographic ST changes in patients with suspected CAD.
• To investigate asynergy in patients with different chest pain presentations and hypertrophic cardiomyopathy (HCM).

Summary:

• Exercise 2-D echocardiography revealed left ventricular asynergy in most patients with angina of effort (10/12) and ST depression (11/12).
• In spontaneous angina patients, asynergy and ST depression occurred in 2/8 without pain, both having severe (≥90%) coronary stenosis.
• Exercise-induced asynergy was also noted in 4/7 HCM patients without coronary stenosis, suggesting ischemia due to myocardial hypertrophy and impaired relaxation.

Impact:

• Exercise echocardiography is a valuable tool for diagnosing coronary artery disease, especially in cases with atypical presentations.
• The study suggests that left ventricular asynergy during exercise can indicate significant coronary artery stenosis even without typical anginal symptoms.
• Findings in hypertrophic cardiomyopathy patients suggest a non-coronary mechanism for exercise-induced myocardial ischemia.