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[Stress echocardiography with physical burden using step-climbing for the diagnosis of ischemia]
Insights
Stress echocardiography using a step-climbing test reliably predicts coronary heart disease (CHD). This method shows good sensitivity and specificity for detecting ischemia, making it a valuable diagnostic tool for patients with suspected CHD.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Non-invasive Cardiac Testing
Background:
- Coronary heart disease (CHD) is a leading cause of morbidity and mortality.
- Accurate and early diagnosis of CHD is crucial for effective patient management.
- Non-invasive diagnostic modalities are preferred for initial patient assessment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of stress echocardiography (SEG) utilizing a standardized step-climbing test.
- To determine the reliability of SEG in predicting significant coronary artery stenosis (≥50%).
- To compare SEG findings with results from coronary angiography.
Main Methods:
- A prospective study included 174 patients with suspected or known CHD progression.
- Stress echocardiography was performed using a standardized step-climbing protocol.
- Results were compared against findings from coronary angiography.
Main Results:
- SEG demonstrated a sensitivity of 81% and specificity of 74% for detecting ischemia in patients with ≥50% coronary artery stenosis.
- Positive and negative predictive values were 81% and 73%, respectively.
- The test showed higher sensitivity for detecting ischemia in the left anterior descending artery distribution compared to other coronary artery territories.
Conclusions:
- Stress echocardiography with a step-climbing test provides acceptable diagnostic performance for coronary heart disease.
- This non-invasive method is a reliable tool for identifying significant coronary artery disease.
- SEG findings correlate well with coronary angiography, supporting its clinical utility.
Objective:
To ascertain the reliability of stress echocardiography (SEG) with a standardized step-climbing test in predicting significant coronary heart disease (CHD) in patients suspected of having CHD, subsequently verified by coronary angiography.
Patients And Methods:
174 consecutive patients (116 men, 58 women; average age 60 years) suspected of having CHD or with suspected progression of known CHD were included.
Results:
Compared with coronary angiography SEG had a sensitivity of 81% for the recognition of ischaemia in patients with coronary artery stenosis of 50% or more, with a specificity of 74%. The positive and negative predictive values were 81% and 73%, respectively. Multi-vessel disease was better recognized then single-vessel involvement. Abnormal perfusion in the region supplied by the left anterior descending artery (LAD) was diagnosed with a higher sensitivity than those of the circumflex branch (CXB) and the right coronary artery (RCA/CXB). For 50% stenoses in the LAD distribution the sensitivity was 76%, specificity 79%; for the combined RCA/CXB and CXB areas the sensitivity was 52%, specificity 84%. When comparing the SEG findings with coronary stenoses of 50%, the sensitivity for diagnosing ischaemia rose to 86%, specificity 70%. Positive and negative predictive values were 83% and 75%, respectively. Ischaemia in the LAD distribution area was recognized with a sensitivity of 79%, specificity 72%, ischaemia in the combined RCA/CXB and CXB areas with a sensitivity of 56%, specificity 82%.
Conclusion:
Stress echocardiography with stair-climbing can achieve acceptable results in the diagnosis of coronary heart disease.