DYNAMIC STRESS ECHOCARDIOGRAPHY FOR EVALUATING ANTIISCHEMIC DRUG PROFILES IN POST-MI PATIENTS

Exercise ECG is an established method of evaluating the anti-ischemic properties of drugs. However, there are considerable methodologic limi tations to this procedure and its use is restricted to patients with e xercise-provoked ECG alterations which can be interpreted as ischemia. The principal, earlier onset of wall motion abnormalities according t o the ischemic cascade can be detected by stress echocardiography and might be utilized as a pharmacological stress testing modality. Sixtee n consecutive patients (15 men, one woman; 53 +/- 9 years old) with an giographically proven coronary artery disease (8 with one-, 5 with two -, and 3 with three-vessel disease) and exercise-induced wall motion a bnormalities were examined by dynamic stress echocardiography (50 watt followed by 20-watt increases/min). Anti-ischemic drugs were withdraw n prior to and on day 1; on the following day 2, 0.2 mu g/kg/min nisol dipine was infused intravenously during the test after a 3 mu g/kg bol us was given. At maximum comparable workload 15/16 patients showed an improved wall motion score on treatment (day 1: 22.9 +/- 4.9 vs day 2: 20.0 +/- 3.9; normal score: 12; one-sided binomial test: p = 0.0003). Eight of 16 patients demonstrated ST-segment deviations on day 1 and day 2. The double product did not differ at any workload stage until t he maximum of 130 watt (day 1: 14101 +/- 3140 vs day 2: 13365 +/- 2865 ; n.s.). Dynamic stress echocardiography seems to be a valuable tool i n pharmacologic stress testing and in terms of accuracy is supposed to be superior to conventional exercise EGG. Nisoldipine reduces exercis e-induced wall motion abnormalities in patients with and without exerc ise-induced ECG alterations. The data result from a controlled pilot s tudy, and further studies are required to confirm these promising meth odological and therapeutic findings.