THE DIAGNOSTIC-VALUE OF EXERCISE ECHOCARDIOGRAPHY IN ISCHEMIC-HEART-DISEASE IN RELATION TO QUANTITATIVE CORONARY ARTERIOGRAPHY

The aim of the study was to assess the diagnostic value of bicycle exe rcise echocardiography using quantitative coronary arteriography as a reference. Exercise echocardiography was performed in 70 consecutive p atients referred for coronary angiography. Digital loops were obtained at rest, peak, and immediately after exercise in the standard views ( parasternal long and short axis, apical two and four chamber views). W all motion analysis was made on the basis of the 16 segment model, sco ring each segment from 3 (hyperkinesia) to - 1 (hypokinesia). Exercise echocardiography was considered positive when wall motion in at least one segment decreased at least one score from rest to peak or post ex ercise. Cinefilms were evaluated using automated quantitative coronary arteriography software. Transstenotic pressure gradients were calcula ted based on flow assumptions at the maximal stenosis flow reserve. Pr essure losses > 30 mmHg and quantitatively measured percent diameter s tenosis of > 50% were considered clinically significant. Stenoses in t he equivocal range of 40-69% were subjected to separate analysis. Exer cise echocardiography was superior to exercise-induced ST-segment depr ession in the diagnosis of coronary artery disease. In the overall sam ple of 70 patients, the sensitivity of exercise echocardiography again st percent diameter stenosis was 84%, against pressure gradient 86%. T he specificity against these two parameters was 86% and 84%, respectiv ely. When analysing the subgroup of 40-69% stenoses (N = 14), sensitiv ity of exercise echocardiography against percent diameter stenosis was 67%, against pressure gradient 88%. The specificity against these two parameters was 100% and 84%, respectively. In conclusion, exercise ec hocardiography has a high diagnostic sensitivity and specificity for d etecting ischemic heart disease in symptomatic patients. In particular , in the subgroup of patients with coronary artery stenoses in the equ ivocal range of 40-69%, the sensitivity of exercise echocardiography w as higher against the physiologic parameter 'transstenotic pressure gr adient' than against quantitative geometric analysis alone of coronary angiograms.