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

Safety and feasibility of dopamine‐atropine stress echocardiography

“…Garot et al demonstrated that the severity of coronary stenosis correlates better with ischemic threshold based on RPP rather than heart rate ( r = −.72 vs r = −.52). They also showed that a third of patients with 70%‐80% diameter stenosis require a RPP >18 000 to demonstrate ischemia and nearly all patients with ≥50% stenosis who achieved RPP >25 000 manifested ischemic wall motion abnormalities 12 …”

“…They also showed that a third of patients with 70%-80% diameter stenosis require a RPP >18 000 to demonstrate ischemia and nearly all patients with ≥50% stenosis who achieved RPP >25 000 manifested ischemic wall motion abnormalities. 12 Along with cavity dimension and wall thickness, systolic pressure is an important but often ignored component of ventricular wall stress that contributes to myocardial oxygen consumption. Wall stress and myocardial oxygen consumption are lower than desired in subjects with small cavity size, and there may be declines in blood pressure and vascular resistance with stress, which routinely occur in ALD patients undergoing DSE.…”

Supine Bicycle Echocardiography

“…Evaluation of changes in myocardial function during graded pharmacologic stress testing with either dobutamine or dipyridamole has been related to the severity of the coronary stenosis (13,14,17). In a study evaluating patients with single-vessel disease and BEE where exercise was stopped at the onset of ischemia, Garot et al (18) demonstrated that the ischemic threshold during exercise also relates to the severity of stenosis. The present study extends these observations to patients undergoing symptom-limited exercise and shows that the ischemic threshold in patients with single or multivessel disease relates inversely to the severity of coronary stenosis, better than at peak exercise.…”

Echocardiographic Monitoring Throughout Exercise

“…The onset of electrocardiographic abnormalities or chest pain is known to be unrelated to the ischemic threshold that can be assessed during exercise echocardiography by determining the level of myocardial oxygen demand at which ischemia develops. The online identification of ischemic threshold has been shown to be reliable and reproducible (13). The heart rate-blood pressure product at the ischemic threshold is correlated with the severity of coronary stenosis: r ϭ Ϫ0.61 in the study by Park et al (6) and r ϭ Ϫ0.72 in the study by Garot et al (13).…”