[Stress echocardiography in the selection of patients for coronarography]

Exercise echocardiography has in recent years become the best non-invasive method for detection of IHD. The authors made an investigation with the objective to test the feasibility of exercise echocardiography, under our technically imperfect but generally available conditions, for the selection of patients for coronarography. In 44 consecutive patients (30 men, 14 women, mean age 50 years) the authors used before planned coronarography exercise echocardiography and 24-hour monitoring of ECG according to Holter with evaluation of ST segments. The results of all three non-invasive methods were compared with the coronarographic findings. The criterium of positivity of coronarographies was 75% stenosis. Such a stenosis is an unequivocal indication for cardiosurgery or percutaneous angioplasty. On comparison of results of non-invasive examination methods with coronarographic findings the best indicators as regards reliability were obtained with exercise echocardiography. Its sensitivity was 71%, specificity 69%, positive predictive value 77% and negative predictive value 61%. The sensitivity of exercise echocardiography increased, depending on the number of affected arteries (50, 71 and 100%). On isolated evaluation of findings in individual main coronary arteries the sensitivity was highest in the area supplied from the ramus interventricularis anterior (67%), the specificity was 77%. For the ramus circumflexus the sensitivity was 50% and the specificity 96%. For the right coronary artery the sensitivity was 25% and the specificity 96%. The sensitivity of exercise ECG (44%) was even lower than Holter sensitivity (57%). The specificity, on the other hand, was lower in Holter (47%) than in exercise ECG (61%). Electrocardiographic methods were not, contrary to echocardiography, usable for evaluation fo the extent of damage.(ABSTRACT TRUNCATED AT 250 WORDS)