Comparison of treadmill exercise echocardiography before and after exercise in the evaluation of patients with known or suspected coronary artery disease

Objectives: We sought to compare the feasibility and accuracy of peak tread mill exercise echocardiography versus postexercise echocardiography imaging . Background: Although peak exercise echocardiography has been reported for b oth supine and orthostatic bicycle exercise and has shown higher sensitivit y than postexercise imaging, acquiring images at peak exercise with treadmi ll has not been explored. Methods: Peak and post-treadmill exercise echocardiography and coronary ang iography mere performed on 89 patients with known or suspected coronary art ery disease, Positive exercise echocardiography was defined as necrosis or ischemic response, Positive coronary angiography was defined as greater tha n or equal to 1 diseased vessels (greater than or equal to 50% luminal narr owing). Images were analyzed in a blind manner by an expert observer. Results: Postexercise images were acquired within 80 seconds after exercise (40 +/- 14). Mean heart rate (bpm) was 139 +/- 22 at peak versus 118 +/- 2 5 at postexercise imaging (P < .001). Interpretable peak and postexercise i mages were obtained for all 89 patients, Of the 72 classified as having pos itive exercise echocardiography, 23 had new regional wall motion abnormalit y at peak (21 with positive angiography), which resolved at postexercise im aging. Sensitivity was higher with peak than with postexercise imaging (94% vs 73%, P < .001). Specificity was similar (68% vs 79%), as mas predictive positive value (92% vs 93%). Negative predictive value was again higher wi th peak imaging (76% vs 44%, P < .05). Total accuracy was higher with peak imaging (89% vs 74%, P < .05). Conclusions: Peak treadmill exercise echocardiography is technically feasib le and has higher sensitivity and accuracy than post-treadmill exercise ech ocardiography. Therefore in the clinical setting peak exercise echocardiogr aphy should be performed to diagnose ischemia.