CLINICAL AND PROGNOSTIC USEFULNESS OF SUPINE BICYCLE EXERCISE ECHOCARDIOGRAPHY IN THE FUNCTIONAL-EVALUATION OF PATIENTS UNDERGOING ELECTIVEPERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Background Supine bicycle exercise echocardiography (SBEE) has never b een used before and early after percutaneous transluminal coronary ang ioplasty (PTCA) for assessing the functional outcome of the procedure and predicting late restenosis. Methods and Results We selected 76 sub jects with stable angina, normal wall motion at rest, and exercise-ind uced wall-motion abnormalities before PTCA. SBEE with peak exercise im aging and the use of a 16-segment, four-grade score model was performe d 54+/-15 hours after PTCA. No exercise-related adverse events occurre d. Patients were grouped according to SBEE results: group 1 (n=35, 46% ) with negative exercise ECG and echo, group 2 (n=19, 25%) with a posi tive exercise ECG but normal echo. and group 3 (n=22, 29%) with a posi tive exercise echo with either a positive (n=7, 32%) or negative (n=15 , 68%) EGG. Exercise performance significantly improved in all groups. In group 3, peak wall-motion score index decreased from 1.27+/-0.11 b efore to 1.15+/-0.06 after PTCA (P<.05), and duration of wall-motion a bnormalities went from 81+/-24 to 47+/-19 seconds (P<.05). The rate of clinical restenosis tie, angina recurrence or positive 6-month SBEE i n asymptomatic patients, both associated with angiographic restenosis >50%) was 37%. By multiple logistic regression analysis, clinical rest enosis was associated with a positive post-PTCA exercise echo (odds ra tio [OR] 3.08, 95% confidence interval [CI] 1.66 to 5.72; P=.0004) and with increasing values of pre-PTCA wall-motion score index (OR 2.86, 95% CI 1.92 lo 4.27; P=.005) and duration of wall-motion abnormalities (QR 2.12, 95% CI 1.07 to 4.20; P=.04). Conclusions SBEE is a safe and reliable tool to demonstrate changes in exercise-induced wall-motion abnormalities after PTCA and provides prognostic information in the ri sk assessment of clinical restenosis.