Validation of Treadmill Exercise Two-Dimensional Echocardiography in Patients with Coronary Artery Disease

Kim, Kwon Sam; Kang, Heung Sun; Choue, Chung Whee; Kim, Myung Shick; Song, Jung Sang; Bae, Jong Hoa

Abstract

BACKGROUND
Exercise echocardiography(ECG) has widely accepted as a simple screening test for coronary artery disease(CAD). But this technique also has well known limitations.Recently numerous studies supports the usefulness of exercise echocardiography(ECHO) for detection of CAD. To determine the value of exercise ECHO for detecting CAD, 54 patients without resting wall motion abnormalities were studied. METHOD: Two-dimensional echocardiogram of parasternal and apical view were recored at rest and immediately after treadmill exercise.The rest and corresponding post-exercise images were analyzed side by side in a continous loop. An abnormal exercise ECHO was defined as wall motion abnormalities after exercise. These wall motion abnormalities were used to predict the extent and distribution of CAD. Significant CAD was difined as a stenosis of luminal diameter more than 50% by coronary arteriography. RESULTS: In 36 patients with significant CAD, exercise ECHO had a higher sensitivity than exercise ECG(86.1% vs 55.6%, P<0.005). The two test had similar specificity (88.9%, respectively). Among 19 patients with single vessle disease, exercise ECHO was significantly than exercise ECG(84.2% vs 42.1%, P<0.05). Among 17 patients with multivessle disease, the two test had similar sensitivity(88.2% vs 70.6%). The sensitivity detection of individual vessle involvement with exercise ECHO was 82.1% for the left anterior descending artery, 76.9% for the right coronary artery and 66.7% for the left circumflex artery. CONCLUSIONS: These results seggest that exercise ECHO is highly specific and more sensitive than exercise ECG for the detection of CAD. The inclusion of exercise ECHO improves the sensitivity of treadmill stress test and aids in localizing the region of ischemia.