The Usefulness of Supine Bycycle Stress Echocardiography for Evaluationg Coronary Artery Disease: Comparision with Exercise Electrocardiography

Han, Seong Wook; Kim, Kee Sik; Kim, Ki Young; Nam, Chang Wook; Kim, Seong Yeol; Kim, Yoon Nyun; Kim, Kwon Bae

Abstract

BACKGROUND AND OBJECTIVES: Posttreadmill exercise echocardiography or supine bicycle exercise echocardiography are widely used for evaluating coronary artery disease. In comparison with posttreadmill exercise echocardiography, supine bicycle stress echocardiography (SBSE) has the advantage of imaging during stress and at peak exercise and ischemic wall motion abnormalities at the time of imaging are more frequent and more extensive. Therefore, SBSE is a valuable tool for evaluation of coronary artery disease. This study was designed to provide the hemodynamic changes during exercise and compare the sensitivity, specificity and predictive values of the wall motion abnormalities of supine bicycle stress echocardiography during peak exercise with those of 12-lead electrocardiography (ECG) during exercise for evaluating coronary artery disease.
MATERIALS AND METHODS
One hundred patients for evaluation of possible coronary artery disease performed supine bicycle stress echocardiography. This study consisted of 51 patients who underwent coronary arteriography. Significant coronary artery disease was defined as the presence of 50% or 75% diameter reduction determined by magnified electronic caliper measurements, compairing the accuracy of supine bicycle stress echocardiography to that of 12-lead exercise ECG.
RESULTS
1) Fifty-one patients (31 men, 20 women) underwent both supine bicycle stress echocardiography and coronary arteriography, the results were age (54.5+/-9.8 years), heart rates(68+/-12 vs 12422 beats/min), systolic blood pressure (130+/-23 vs 175+/-32 mmHg), diastolic blood pressure (76+/-13 vs 96+/-25mmHg) in resting vs during peak exercise and % predicted maximal heart rate (72+/-10%). 2) At coronary artery disease was defined as the presence of 50% diameter reduction, 26 of 51 patients were included(19 with single-vessel, 6 with double-vessel and 1 with triple-vessel disease). SBSE was 69.2% sensitivity, 64% specificity, 66.7% positive predictive value and 66.7% negative predictive value compared with 33.3% sensitivity, 70.8% specificity of ECG during exercise. 3) At coronary artery disease was defined as the presence of 75% diameter reduction, 19 of 51 patients were included(16 with single-vessel and 3 with double-vessel disease). SBSE was 84.2% sensitivity, 65.6% specificity, 59.3% positive predictive value and 45.8% negative predictive value compared with 31.6% sensitivity, 68.7% specificity of 12-lead ECG during exercise. 4) There were no serious complications like that ventricular tachycardia or fibrillation, severe hypotension or hypertension, acute myocardial infarction and death during exercise test.
CONCLUSIONS
The sensitivity of supine bicycle stress echocardiography during peak exercise was higher than 12-lead ECG during exercise for evaluation of coronary artery disease because wall motion abnormality of echocardiography was more early detected than ECG changes during exercise at same amounts of workload. Therefore, supine bicycle stress echocardiography is a useful tool for evaluating coronary artery disease.