CLINICAL-APPLICATION OF EXERCISE STRESS ECHOCARDIOGRAPHY - SUPINE BICYCLE OR TREADMILL

Although exercise stress echocardiography is currently used to evaluat e coronary artery disease (CAD) patients, the best exercise methodolog y is still undefined. The objectives of the study were: (1) to compare supine bicycle stress echocardiography (SBSE) and treadmill in the ev aluation of CAD; and (2) to define, in normal subjects, the different behavior of factors determining MVO2 wish treadmill and SBSE. We selec ted 10 male patients with CAD (group A), and 10 male control subjects (group B). Each patient underwent SBSE and tread-mill testing in rando m order. We studied heart sate, systolic blood pressure, heart rate x systolic blood pressure, and end-diastolic and end-systolic volume ind exes. in group A, we also studied wall motion score index (according t o the American Society of Echocardiography) and in group B, systolic b lood pressure/end-systolic volume index. The results were as follows: Group A: SBSE resulted in significantly lower work load, heart rate, a nd significantly higher systolic blood pressure, heart hate x systolic blood pressure, end-diastolic volume index, end-systolic volume index , and wall motion score index. SBSE showed wall motion abnormalities i n each patient, whereas treadmill did not detect wail motion abnormali ties in 4 patients (3 single-vessel; 1 multivessel); of the other 6 pa tients, 2 showed a lower wall motion score index and 4 did not show an y difference in left ventricle kinetics with the 2 methodologies of ex ercise. Mean acquisition time for postexercise images was 72 +/- 6 sec onds. Group B: SBSE resulted in lower work load, heart rate, heart rat e x systolic blood pressure, systolic blood pressure/end-systolic volu me index, and higher end-diastolic volume index and end-systolic volum e index. Systolic blood pressure was similar with SBSE and treadmill t esting. In conclusion, our experience suggests SBSE is a highly accura te diagnostic fool for evaluating CAD compared with treadmill testing; the maximum cardiovascular performance can be achieved With lower val ues of heart rate, suggesting the echo test is more feasible. Treadmil l testing could lose important information about the existence, extens ion, and location of CAD; ire contrast, SBSE detects even small, quick ly reversible wall motion abnormalities. (C) 1998 by Excerpta Medica, Inc.