Supine bicycle stress echocardiography: peak exercise imaging is superior to postexercise imaging

The abilities of peak exercise (PEAK) stress echocardiography versus postexercise (POST) stress echocardiography to detect coronary artery disease were evaluated in 136 consecutive patients undergoing supine bicycle stress echocardiography and coronary arteriography: 42 (31%) had normal coronary vessels, 38 (28%) had single-vessel disease, 34 (25%) had double-vessel disease, and 22 (16%) had triple-vessel disease. The results were as follows: (1) For detection of disease in the group of patients, sensitivity of PEAK versus POST was 94% versus 83% (p < 0.01) and specificity was 88% versus 90%. (2) For detection of disease in specific vessels, sensitivity of PEAK versus POST was 90% versus 72% (p < 0.0001) and specificity was 89% versus 92%. (3) For evaluation of the three major coronary arteries, sensitivity of PEAK versus POST was 96% versus 85% (p < 0.05) for the left anterior descending artery, 90% versus 65% (p < 0.01) for the right coronary artery, and 79% versus 60% (p < 0.05) for the left circumflex coronary artery. There were no differences in specificity. (4) The percent diameter stenosis of vessels normalizing from PEAK to POST versus vessels abnormal at PEAK and POST was 80.6% +/- 16% versus 85.9% +/- 14%, p = 0.07. There were no differences in exercise parameters between patients with and without resolution from PEAK to POST. (5) PEAK versus POST accuracy for identification of patients with multivessel disease was 93% versus 68% (p < 0.001). We conclude that stress echocardiography performed during peak exercise is superior to postexercise stress echocardiography.