Usefulness of Exercise Echocardiography in Early Detection of Multivessel Coronary Artery Disease after Uncomplicated Myocardial Infarction

Abstract

To evaluate the exercise echocardiography (EE) accuracy in identifying the presence of multivessel coronary artery disease (MVD) early after myocardial infarction (MI), 76 consecutive patients underwent coronary angiography and EE 10-15 days after uncomplicated MI. Left-ventricular wall motion abnormalities localised to more than one vascular territory were considered as the échocardiographie marker of MVD. To quantify ventricular dysfunction, a wall motion score index was calculated and the difference between baseline and exercise values (ΔWMSI) was recorded. EE correctly identified 26/33 MYD patients (sensitivity 79%), and 36/43 single-vessel disease (SVD) patients (specificity 84%). The MVD patients were more likely to have exercise- induced wall motion abnormalities (69 vs. 35% in the SVD group), which more frequently involved vascular regions with normal resting function (36% of MVD vs. 5% of SVD patients). After exercise, MVD patients showed a variable degree of ventricular dysfunction but a trend to a greater impairment of regional function was identified: ΔWMSI 0.261 ± 0.21 in MVD vs. 0.162 ± 0.09 in SVD patients (p = 0.06). In conclusion, in asymptomatic patients, after uncomplicated MI, EE allows the presence and the functional significance of MVD to be assessed nonin vasively with good accuracy.