EXERCISE ECHOCARDIOGRAPHY PERFORMED EARLY AND LATE AFTER PERCUTANEOUSTRANSLUMINAL CORONARY ANGIOPLASTY FOR PREDICTION OF RESTENOSIS

The purpose of this prospective study was to examine the incidence of exercise-induced ischaemia before and after angioplasty as well as 4 m onths later by exercise echocardiography, to evaluate the prognostic v alue of exercise echocardiography performed after angioplasty as regar ds the development of restenosis and to determine whether serial exerc ise tests increase the accuracy of detecting angiographically relevant restenosis. Fifty patients (39 males; mean age 52+/-9 years) without prior Q wave infarction entered the study protocol. Exercise echocardi ography was performed 2 days prior to angioplasty, 13+/-6 days after s uccessful angioplasty as well as at routine follow-up angiography 3.8/-1.6 months after angioplasty. Angiographically successful angioplast y was achieved in 94% (47/50) of patients, and early and late follow-u p examinations were performed in all 47 patients. Average luminal diam eter stenosis decreased from 65+/-5% to 26+/-9% immediately after angi oplasty. Control angiography showed significant restenosis in 30% (14/ 47) of patients. Exercise echocardiography before angioplasty was posi tive in 90%, continued to be positive in 30% of patients after angiopl asty and was positive in 43% at control angiography. The exercise echo cardiogram performed early after angioplasty had all overall accuracy for prediction of restenosis of 70%, with a positive predictive value of 50% and a negative predictive value of 79%. Sensitivity for detecti on of restenosis at control angiography was high (86%), but specificit y (76%) was moderate. Exercise echocardiograms showing deterioration f rom 2 weeks to 4 months after angioplasty were taken as a sign of rest enosis and resulted in an increased specificity of 94%. Sensitivity, h owever, decreased to 36%, indicating that some patients with an early positive stress echo had already suffered restenosis 13 days after ang ioplasty. In conclusion, exercise echocardiography documents improveme nt in regional function after angioplasty. However, a significant prop ortion of patients continue to have a positive exercise echocardiogram even though angioplasty was angiographically successful, probably due to persistent ischaemic regions or early restenosis. While exercise e chocardiography performed early after angioplasty is of insufficient v alue for the prediction of restenosis, if performed at late follow-up it has a good diagnostic accuracy for detecting restenosis.