Exercise testing and dipyridamole echocardiography test before and 48 h after successful coronary angioplasty: prognostic implications

Abstract

The purpose of the present study was to determine the value of exercise testing (ET) and dipyridamole echocardiography test (DET) in the early functional evaluation after a successful coronary angioplasty (PTCA) and in the prediction of angina recurrence. 52 patients underwent ET and DET before and 48 h after a successful PTCA. During a 6-12 month follow-up period they all underwent clinical evaluation. Before PTCA, ET was positive in 49 of 52 patients (94%) and new asynergies were detected by DET in 47 of 52 patients (90%). 48 h after PTCA 23 patients (44%) had positive ET results and 10 had a positive DET response. During the follow-up, 17 patients experienced recurrence of angina. Positive predictive value (PPV) for angina recurrence of ET and DET performed early after the PTCA were, respectively, 57 and 80%. The PPV of ET increased to 88% when electrocardiographic (ECG) positivity was accompanied by angina. Negative predictive values of ET and DET were, respectively, 86% and 79%. Early after PTCA, exercise ECG positivity was not predictive of symptom recurrence while ECG positivity associated with angina revealed a high PPV, similar to that of DET.

Use and Limitations of Immediate Postprocedural Intracoronary Doppler Blood Flow Measurements for Predicting Late Result after Coronary Balloon Angioplasty

“…However, in approximately 50% of patients undergoing successful balloon angioplasty, a discrepancy has been observed and early postinterventional physiologic measurements such as coronary flow reserve [12], thallium-201 scintigraphy [13,14], dobutamine echo [15], exercise testing [15,16], or cardiac posi tion emission tomographic (PET) scanning [17] are ab normal despite a satisfactory angiographic appearance of the lesion. An abnormal physiologic study in the early postangioplasty period identifies a subset of patients at increased risk for late coronary restenosis [13][14][15][18][19][20]; a normal thallium-201 SPECT perfusion test 18-24 h after angioplasty stratifies a group of patients with low risk of late restenosis (negative predictive value approxi mately 90%) [14,20].…”