Accuracy and limitations of exercise echocardiography in a routine clinical setting

Abstract

Despite the high reported accuracy of exercise echocardiography in the detection of coronary artery disease, factors that compromise its sensitivity and specificity are less clear. This study examined the results of 179 post-treadmill stress echocardiograms in 150 consecutive patients who also underwent cardiac catheterization and in 29 normal persons at low risk for coronary artery disease. Of 114 patients who had significant coronary stenoses at angiography, 96 had an abnormal exercise echocardiogram (overall sensitivity 84%). False negative results correlated with the performance of submaximal exercise, single-vessel disease and moderate (50% to 70% diameter) stenoses. After the exclusion of seven patients performing submaximal exercise, the sensitivity was 90%. In 54 patients without previous infarction performing maximal exercise, the sensitivity was 87%, higher in patients with multivessel coronary disease (96%) than in those with single-vessel disease (79%). After the exclusion of patients with nondiagnostic results, due either to the performance of submaximal stress or the presence of electrocardiographic (ECG) changes at rest, exercise echocardiography had a higher sensitivity than did exercise electrocardiography (87% vs. 63%, p = 0.01). In 36 patients without significant coronary disease, exercise echocardiography had an overall specificity of 86%. After the exclusion of patients with a nondiagnostic test, exercise echocardiography had a specificity of 82% compared with 74% specificity for exercise electrocardiography (p = NS). Similarly, of the 29 normal subjects, 93% had a normal exercise echocardiogram and 97% had a normal exercise ECG (p = NS). Similarly, of the 29 normal subjects, 93% had a normal exercise echocardiogram and 97% had a normal exercise ECG (p = NS). Age, gender, body weight and image quality did not significantly influence the accuracy of exercise echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Incremental Benefit of Myocardial Contrast to Combined Dipyridamole-Exercise Stress Echocardiography for the Assessment of Coronary Artery Disease

“…Nevertheless, ExE has a number of limitations, including its dependence on the provocation of wall-motion abnormalities (WMAs) for the diagnosis of ischemia, reliance on qualitative wall-motion scoring, 2 and underestimation of the extent of CAD. 1,3 Radionuclide perfusion imaging appears to be more accurate for determining the extent of CAD, 3 probably because hypoperfusion occurs before WMAs are evident in the ischemic cascade. 4 Myocardial contrast echocardiography (MCE) enables assessment of myocardial perfusion by ultrasound.…”

“…xercise echocardiography (ExE) is an established clinical tool with a high sensitivity and specificity 1 for the diagnosis of coronary artery disease (CAD). Nevertheless, ExE has a number of limitations, including its dependence on the provocation of wall-motion abnormalities (WMAs) for the diagnosis of ischemia, reliance on qualitative wall-motion scoring, 2 and underestimation of the extent of CAD.…”

Stratification of single-vessel coronary stenosis by ischemic threshold at the onset of wall motion abnormality during continuous monitoring of left ventricular function by semisupine exercise echocardiography

“…34 A false-negative response on EE among patients with significant coronary artery stenosis correlates well with the performance of a submaximal exercise (<85% of the maximal agepredicted heart rate), single-vessel disease, and moderate stenoses from 50% to 70%. 7 In the current report, the mean maximal heart rate achieved among patients with a negative response on EE was 87% of the maximal predicted heart rate.…”

“…3 Exercise echocardiography (EE) is an accepted tool for the assessment of the functional significance of coronary obstructions among patients with coronary artery disease (CAD). [4][5][6][7][8] In previous reports, the classification of CAD has been mostly semiquantitative, assessed by visual analysis, or based on predetermined cutoff values of angiographic parameters. 4,5,[7][8][9][10] A few studies that used quantitative analysis of coronary stenosis have demonstrated the diagnostic accuracy of EE for the detection of significant CAD in selected patients with single-vessel disease and normal echocardiograms at rest.…”

“…[4][5][6][7][8] In previous reports, the classification of CAD has been mostly semiquantitative, assessed by visual analysis, or based on predetermined cutoff values of angiographic parameters. 4,5,[7][8][9][10] A few studies that used quantitative analysis of coronary stenosis have demonstrated the diagnostic accuracy of EE for the detection of significant CAD in selected patients with single-vessel disease and normal echocardiograms at rest. 1,2 They have established that the severity of a coronary stenosis assessed by quantitative coronary angiography can predict an ischemic response on EE and that the functional significance of a coronary narrowing is better correlated to exercise-induced wall motion abnormality (WMA) on echocardiography than other usual markers of exercise-induced myocardial ischemia.…”