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Grading of Ischemic Response

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Stress Echocardiography

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Abstract

The need for a dichotomy (yes/no) classification of the results of both provocative tests (positive or negative) and coronary angiography (disease present or absent) in conventional sensitivity/specificity analysis of test results has at least three important limitations [1]:

  1. 1.

    Coronary artery disease is not an “all or none” condition; a binary classification requires arbitrary threshold criteria and creates artificial distinctions in coronary artery disease, which in reality shows a continuous spectrum of severity.

  2. 2.

    Sensitivity and specificity values tend to be affected by the disease distribution in the study population; a sample distribution with a high frequency of mild disease will be placed centrally near the threshold values, where scatter is more likely to lower sensitivity and specificity [2].

  3. 3.

    Percent diameter narrowing is not an adequate standard for quantifying stenosis severity in clinical studies [3]; in unselected populations, this anatomical parameter has a poor correlation with the coronary flow reserve (see Chap. 2).

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References

  1. Demer LL, Gould KL, Goldstein RA, et al (1989) Assessment of coronary artery disease severity by positron emission tomography. Comparison with quantitative arteriography in 193 patients. Circulation 79:825–835

    Article  PubMed  CAS  Google Scholar 

  2. Hlatky MA, Mark DB, Harreil FE Jr, et al (1987) Rethinking sensitivity and specificity. Am J Cardiol 59:1195–1198

    Article  PubMed  CAS  Google Scholar 

  3. Marcus ML, Skorton DJ, Johnson MR, et al (1988) Visual estimates of percent diameter coronary stenosis: “a battered gold standard”. J Am Coll Cardiol 11:882–885

    Article  PubMed  CAS  Google Scholar 

  4. Sawada SG, Segar DS, Ryan T, et al (1991) Echocardiographic detection of coronary artery disease during dobutamine infusion. Circulation 83:1605–1614

    Article  PubMed  CAS  Google Scholar 

  5. Picano E, Alaimo A, Chubuchny V, et al (2002) Noninvasive pacemaker stress echocardiography for diagnosis of coronary artery disease: a multicenter study. J Am Coll Cardiol 40:1305–1310

    Article  PubMed  Google Scholar 

  6. Parodi G, Picano E, Marcassa C, et al (1999) High-dose dipyridamole myocardial imaging: simultaneous sestamibi scintigraphy and two-dimensional echocardiography in the detection and evaluation of coronary artery disease. Coron Artery Dis 10:177–184

    Article  PubMed  CAS  Google Scholar 

  7. Marwick T, D’Hondt AM, Baudhuin T, et al (1993) Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: combination with echocardiography or scintigraphy, or both? J Am Coll Cardiol 22:159–167

    Article  PubMed  CAS  Google Scholar 

  8. Armstrong WF, O’Donnell J, Ryan T, et al (1987) Effect of prior myocardial infarction and extent and location of coronary disease on accuracy of exercise echocardiography. J Am Coll Cardiol 10:531–538

    Article  PubMed  CAS  Google Scholar 

  9. Bolognese L, Sarasso G, Bongo AS, et al (1991) Dipyridamole echocardiography test. A new tool for detecting jeopardized myocardium after thrombolytic therapy. Circulation 84:1100–1106

    Article  PubMed  CAS  Google Scholar 

  10. Berthe C, Pierard LA, Hiernaux M, et al (1986) Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol 58:1167–1172

    Article  PubMed  CAS  Google Scholar 

  11. Jaarsma W, Visser CA, Kupper AJ, et al (1986) Usefulness of two-dimensional exercise echocardiography shortly after myocardial infarction. Am J Cardiol 57:86–90

    Article  PubMed  CAS  Google Scholar 

  12. Bolognese L, Sarasso G, Aralda D, et al (1989) High-dose dipyridamole echocardiography early after uncomplicated acute myocardial infarction: correlation with exercise testing and coronary angiography. J Am Coll Cardiol 14:357–363

    Article  PubMed  CAS  Google Scholar 

  13. Chaitman BR (1996) Exercise stress testing. In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine, 5th edn. Saunders, Philadelphia, pp 153–176

    Google Scholar 

  14. Armstrong WF (1988) Exercise echocardiography: ready, willing and able. J Am Coll Cardiol 11:1359–1361

    Article  PubMed  CAS  Google Scholar 

  15. Crouse LJ, Harbrecht JJ, Vacek JL, et al (1991) Exercise echocardiography as a screening test for coronary artery disease and correlation with coronary arteriography. Am J Cardiol 67:1213–1218

    Article  PubMed  CAS  Google Scholar 

  16. Ryan T, Segar DS, Sawada SG, et al (1993) Detection of coronary artery disease with upright bicycle exercise echocardiography. J Am Soc Echocardiogr 6:186–197

    PubMed  CAS  Google Scholar 

  17. Sheikh KH, Bengtson JR, Helmy S, et al (1990) Relation of quantitative coronary lesion measurements to the development of exercise-induced ischemia assessed by exercise echocardiography. J Am Coll Cardiol 15:1043–1051

    Article  PubMed  CAS  Google Scholar 

  18. Segar DS, Brown SE, Sawada SG, et al (1992) Dobutamine stress echocardiography: correlation with coronary lesion severity as determined by quantitative angiography. J Am Coll Cardiol 19:1197–1202

    Article  PubMed  CAS  Google Scholar 

  19. Baptista J, Arnese M, Roelandt JR, et al (1994) Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine-atropine stress test. J Am Coll Cardiol 23:1434–1439

    Article  PubMed  CAS  Google Scholar 

  20. Amico A, Iliceto S, D’Ambrosio G, et al (1987) Evaluation of timing of occurrence of wall motion abnormalities during incremental atrial pacing aids in the prediction of the severity of coronary artery disease. Eur Heart J 8:190–194

    Google Scholar 

  21. Picano E, Parodi 0, Lattanzi F, et al (1994) Assessment of anatomic and physiological severity of single-vessel coronary artery lesions by dipyridamole echocardiography. Comparison with positron emission tomography and quantitative arteriography. Circulation 89:753–761

    Article  PubMed  CAS  Google Scholar 

  22. Picano E, Lattanzi F, Masini M, et al (1987) Different degrees of ischemic threshold stratified by the dipyridamole-echocardiography test. Am J Cardiol 59:71–73

    Article  PubMed  CAS  Google Scholar 

  23. Picano E, Severi S, Michelassi C, et al (1989) Prognostic importance of dipyridamole-echocardiography test in coronary artery disease. Circulation 80:450–457

    Article  PubMed  CAS  Google Scholar 

  24. Lattanzi F, Picano E, Bolognese L, et al (1991) Inhibition of dipyridamole-induced ischemia by antianginal therapy in humans. Correlation with exercise electrocardiography. Circulation 83:1256–1262

    Article  PubMed  CAS  Google Scholar 

  25. Ferrara N, Longobardi G, Nicolino A, et al (1992) Effect of beta-adrenoceptor blockade on dipyridamole-induced myocardial asynergies in coronary artery disease. Am J Cardiol 70:724–727

    Article  PubMed  CAS  Google Scholar 

  26. Fioretti PM, Poldermans D, Salustri A, et al (1994) Atropine increases the accuracy of dobut-amine stress echocardiography in patients taking beta-blockers. Eur Heart J 15:355–360

    Article  PubMed  CAS  Google Scholar 

  27. Dodi C, Pingitore A, Sicari R, et al (1997) Effects of antianginal therapy with a calcium antagonist and nitrates on dobutamine-atropine stress echocardiography. Comparison with exercise electrocardiography. Eur Heart J 18:242–247

    Article  PubMed  CAS  Google Scholar 

  28. Lombardi M, Morales MA, Michelassi C, et al (1993) Efficacy of isosorbide-5-mononitrate versus nifedipine in preventing spontaneous and ergonovine-induced myocardial ischaemia. A double-blind, placebo-controlled study. Eur Heart J 14:845–851

    Article  PubMed  CAS  Google Scholar 

  29. Picano E, Pirelli S, Marzilli M, et al (1989) Usefulness of high-dose dipyridamole echocardiography test in coronary angioplasty. Circulation 80:807–815

    Article  PubMed  CAS  Google Scholar 

  30. Mertes H, Erbel R, Nixdorff U, et al (1993) Exercise echocardiography for the evaluation of patients after nonsurgical coronary artery revascularization. J Am Coll Cardiol 21:1087–1093

    Article  PubMed  CAS  Google Scholar 

  31. Sawada SG, Judson WE, Ryan T, et al (1989) Upright bicycle exercise echocardiography after coronary artery bypass grafting. Am J Cardiol 64:1123–1129

    Article  PubMed  CAS  Google Scholar 

  32. Crouse LJ, Vacek JL, Beauchamp GD, et al (1992) Exercise echocardiography after coronary artery bypass grafting. Am J Cardiol 70:572–576

    Article  PubMed  CAS  Google Scholar 

  33. Rodriguez O, Picano E, Fedele S, et al (2001) Non-invasive prediction of angiographic progression of coronary artery disease by dipyridamole-stress echocardiography. Coron Artery Dis 12:197–204

    Article  PubMed  CAS  Google Scholar 

  34. Rodriguez O, Picano E, Fedele S, et al (2002) Noninvasive prediction of coronary artery disease progression by comparison of serial exercise electrocardiography and dipyridamole stress echocardiography. Int J Cardiovasc Imaging 18:93–99

    Article  PubMed  Google Scholar 

  35. Picano E, Lattanzi F, Distante A, et al (1989) Role of myocardial oxygen consumption in dipyridamole-induced ischemia. Am Heart J 118:314–319

    Article  PubMed  CAS  Google Scholar 

  36. Picano E, Marini C, Pirelli S, et al (1992) Safety of intravenous high-dose dipyridamole echocardiography. The Echo-Persantine International Cooperative Study Group. Am J Cardiol 70:252–258

    Article  PubMed  CAS  Google Scholar 

  37. Picano E, Mathias W Jr, Pingitore A, et al (1994) Safety and tolerability of dobutamine-atropine stress echocardiography: a prospective, multicentre study. Echo Dobutamine International Cooperative Study Group. Lancet 344:1190–1192

    Article  PubMed  CAS  Google Scholar 

  38. Bigi R, Partesana N, Verzoni A et al (1995) Incidence and correlates of complex ventricular arrhythmias during dobutamine stress echocardiography after acute myocardial infarction. Eur Heart J 16:1819–24

    PubMed  CAS  Google Scholar 

  39. De Sutter J, Poldermans D, Vourvouri E et al (2003) Long-term prognostic significance of complex ventricular arrhythmias induced during dobutamine stress echocardiography. Am J Cardiol 91:242–4

    Article  PubMed  Google Scholar 

  40. Hung KC, Lin FC, Chern MS et al (1999) Mechanisms and clinical significance of transient atrioventricular block during dobutamine stress echocardiography. J Am Coll Cardiol 34:998–1004

    Article  PubMed  CAS  Google Scholar 

  41. Rosamond TL, Vacek JL, Hurwitz A, et al (1992) Hypotension during dobutamine stress echocardiography: initial description and clinical relevance. Am Heart J 123:403–407

    Article  PubMed  CAS  Google Scholar 

  42. Pellikka PA, Oh JK, Bailey KR, et al (1992) Dynamic intraventricular obstruction during dobutamine stress echocardiography. A new observation. Circulation 86:1429–1432

    Article  PubMed  CAS  Google Scholar 

  43. Heinle SK, Tice FD, Kisslo J (1995) Hypotension during dobutamine stress echocardiography: is it related to dynamic intraventricular obstruction? Am Heart J 130:314–317

    Article  PubMed  CAS  Google Scholar 

  44. Lieberman EB, Heinle SK, Wildermann N, et al (1995) Does hypotension during dobutamine stress echocardiography correlate with anatomic or functional cardiac impairment? Am Heart J 129:1121–1126

    Article  PubMed  CAS  Google Scholar 

  45. Dhond MR, Whitley TB, Singh S et al (2000) Incidence and significance of profound hypotension during dobutamine stress echocardiography. Clin Cardiol 23:47–50

    Article  PubMed  CAS  Google Scholar 

  46. Day SM, Younger JG, Karavite D et al (2000) Usefulness of hypotension during dobutamine echocardiography in predicting perioperative cardiac events. Am J Cardiol 85:478–83

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1, 56124, Pisa, Italy

    Eugenio Picano MD, PhD, FESC (Senior Medical Researcher of Italian National Research Council, Director, Echocardiography and Stress Testing Lab Institute of Clinical Physiology, Pisa, Scientific Director Cardiology, Clinica Cardiologica Montevergine, Mercogliano, Avellino, Editor-in-Chief Biomed Central Netjournal Cardiovascular Ultrasound)

Authors
  1. Eugenio Picano MD, PhD, FESC
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© 2003 Springer-Verlag Berlin Heidelberg

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Picano, E. (2003). Grading of Ischemic Response. In: Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-05096-5_17

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  • DOI: https://doi.org/10.1007/978-3-662-05096-5_17

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-05098-9

  • Online ISBN: 978-3-662-05096-5

  • eBook Packages: Springer Book Archive

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