DETECTION OF CORONARY-ARTERY DISEASE BY DIGITAL STRESS ECHOCARDIOGRAPHY - COMPARISON OF EXERCISE, TRANSESOPHAGEAL ATRIAL-PACING AND DIPYRIDAMOLE-ECHOCARDIOGRAPHY

Objectives. This study assessed and compared the diagnostic potential of exercise, transesophageal atrial pacing and dipyridamole stress ech ocardiography in a clinical setting. Background. Although they have be en widely studied, no data exist with regard to comparisons of these p rocedures in a head-to-head study in different clinical settings. Meth ods. One hundred four consecutive patients with suspected coronary art ery disease undergoing coronary angiography and with no previous myoca rdial infarction or rest left ventricular wall motion abnormalities un derwent digital posttreadmill, transesophageal atrial pacing and dipyr idamole echocardiography. Results. Feasibility of digital exercise ech ocardiography was 84%; 8 of 88 remaining patients had a nondiagnostic exercise echocardiographic test (inadequate exercise or imaging). In 8 0 patients with feasible and diagnostic digital exercise echocardiogra phy, sensitivity, specificity and accuracy were, respectively, 89%, 91 % and 90%. Eighty of the 104 patients underwent transesophageal atrial pacing and dipyridamole echocardiography. Feasibility of the alternat ive stress procedures was 77% for transesophageal atrial pacing and 96 % for dipyridamole. In 60 patients successfully undergoing both altern ative stress procedures, sensitivity and specificity were 83% and 76% for atrial pacing and 43% and 92% for dipyridamole echocardiography, r espectively. In the group of 24 patients with nondiagnostic exercise e chocardiography and consequent indication to alternative stress proced ures, accuracy of transesophageal atrial pacing was higher than that o f dipyridamole echocardiography (73% vs. 45%, p = 0.06). Conclusions. Because of its higher diagnostic potential and additional functional i nformation, exercise is the stress of choice when stress echocardiogra phy is used to detect the presence of coronary artery disease. Alterna tive stresses can be used in patients with nondiagnostic exercise echo cardiography. Transesophageal and dipyridamole echocardiography differ in feasibility and diagnostic reliability (higher sensitivity of tran sesophageal atrial pacing, higher specificity of dipyridamole). These characteristics must be considered when selecting procedures to be use d as alternatives to exercise.