DETECTION OF CORONARY-ARTERY DISEASE IN THE PRESENCE OF LEFT-VENTRICULAR HYPERTROPHY

To evaluate the accuracy of exercise echocardiography for the recognit ion of coronary artery disease in the presence of left ventricular hyp ertrophy 70 patients were studied. Significant coronary artery disease was present in 25 patients and left ventricular hypertrophy had 29 pa tients. All patients underwent an exercise ECG and echocardiographic t est during which cine-loop digitized echocardiography was obtained. Wa ll motion was analyzed and a regional wall motion score index was calc ulated The overall sensitivities of exercise ECG and echocardiography for detecting coronary artery disease were 60% and 64%, respectively, and the specificities were 49% and 78%, respectively. In patients with left ventricular hypertrophy the specificity of exercise echocardiogr aphy was higher (71%) compared to exercise ECG (21%) while in patients without hypertrophy the sensitivity was higher (70% vs. 40%, respecti vely). Of the 19 patients with a non-diagnostic stress ECG, echocardio graphy correctly identified 100% of those with coronary artery disease but only 53% of those without disease. It is concluded that exercise digital echocardiography represents a good diagnostic alternative to t he exercise ECG for identifying coronary artery disease in the presenc e of left ventricular hypertrophy and should be useful in patients wit h a non-diagnostic exercise ECG.