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Exercise echocardiography: feasibility and value for detection of coronary artery disease
Insights
Exercise echocardiography (Ex-Echo) is a feasible and accurate method for diagnosing coronary artery disease (CAD), outperforming exercise electrocardiography (Ex-ECG). Wall motion scoring may help differentiate single from multiple vessel CAD.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Coronary artery disease (CAD) diagnosis relies on invasive methods like coronary angiography (CA).
- Non-invasive diagnostic tools are crucial for improving patient outcomes and reducing healthcare burdens.
Purpose of the Study:
- To assess the feasibility and diagnostic accuracy of exercise echocardiography (Ex-Echo) for detecting CAD.
- To compare the performance of Ex-Echo with exercise electrocardiography (Ex-ECG) against coronary angiography (CA).
Main Methods:
- 47 patients with known CAD underwent Ex-Echo and upright exercise electrocardiography (Ex-ECG) within two weeks of CA.
- Echocardiograms were acquired in multiple views before and after treadmill exercise.
- Ex-Echo positivity was defined by hypodynamic left ventricular wall motion post-exercise.
Main Results:
- Successful post-exercise echocardiograms were obtained in 97.8% of patients.
- Ex-Echo demonstrated higher sensitivity (87.5%), specificity (92.8%), and accuracy (89.4%) compared to Ex-ECG.
- Concordance with CA was 90.9% for single-vessel disease and 45.0% for multiple-vessel disease.
Conclusions:
- Exercise echocardiography is a feasible and accurate non-invasive test for diagnosing CAD.
- Wall motion scoring index may aid in distinguishing between single and multiple vessel CAD.
Objective:
To evaluate the feasibility and accuracy of exercise echocardiography (Ex-Echo) for the diagnosis of coronary artery disease (CAD) based on coronary angiography (CA).
Patients And Methods:
Forty-seven patients were found to have CAD and examined by upright exercise electrocardiography (Ex-ECG) on a treadmill within two weeks of CA. Before and immediately after exercise, the patients lay on a bed beside the treadmill in the left lateral position and parasternal long and short axis and apical two and four chamber views of the heart were acquired. Pre- and post-echocardiograms were analysed in a side-by-side multiple screen format on the imaging view and hypodynamic wall motion of the left ventricle after exercise was defined as Ex-Echo positive. The sensitivity, specificity and predictive accuracy of Ex-Echo and Ex-ECG were calculated on the basis of CA data.
Results:
Satisfactory echocardiograms were recorded in 46 patients after exercise. The success rate was 97.8%. Compared with Ex-ECG, Ex-Echo was more sensitive (87.5% vs 62.5%, P < 0.05), specific (92.8% vs 60.0%, P < 0.05) and accurate (89.4% vs 61.7%, P < 0.01). The concord of determining the number of diseased vessels between coronary angiography and Ex-Echo was 90.9% in single vessel disease and 45.0% in multiple vessel disease. Wall motion scoring index, however, was higher in multiple than in single vessel CAD.
Conclusions:
Ex-Echo test is feasible and accurate in detecting CAD and wall motion scoring index is probably useful in distinguishing multiple from single vessel CAD.