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The diagnostic value of exercise echocardiography in ischemic heart disease in relation to quantitative coronary arteriography

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Abstract

The aim of the study was to assess the diagnostic value of bicycle exercise echocardiography using quantitative coronary arteriography as a reference. Exercise echocardiography was performed in 70 consecutive patients referred for coronary angiography. Digital loops were obtained at rest, peak, and immediately after exercise in the standard views (parasternal long and short axis, apical two and four chamber views). Wall motion analysis was made on the basis of the 16 segment model, scoring each segment from 3 (hyperkinesia) to — 1 (hypokinesia). Exercise echocardiography was considered positive when wall motion in at least one segment decreased at least one score from rest to peak or post exercise. Cinefilms were evaluated using automated quantitative coronary arteriography software. Transstenotic pressure gradients were calculated based on flow assumptions at the maximal stenosis flow reserve. Pressure losses > 30 mmHg and quantitatively measured percent diameter stenosis of > 50% were considered clinically significant. Stenoses in the equivocal range of 40–69% were subjected to separate analysis. Exercise echocardiography was superior to exercise-induced ST-segment depression in the diagnosis of coronary artery disease. In the overall sample of 70 patients, the sensitivity of exercise echocardiography against percent diameter stenosis was 84%, against pressure gradient 86%. The specificity against these two parameters was 86% and 84%, respectively. When analysing the subgroup of 40–69% stenoses (N = 14), sensitivity of exercise echocardiography against percent diameter stenosis was 67%, against pressure gradient 88%. The specificity against these two parameters was 100% and 84%, respectively. In conclusion, exercise echocardiography has a high diagnostic sensitivity and specificity for detecting ischemic heart disease in symptomatic patients. In particular, in the subgroup of patients with coronary artery stenoses in the equivocal range of 40–69%, the sensitivity of exercise echocardiography was higher against the physiologic parameter ‘transstenotic pressure gradient’ than against quantitative geometric analysis alone of coronary angiograms.

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Authors and Affiliations

  1. Department of Medicine, Div. of Cardiology, University Hospital (Rigshospitalet), Copenhagen, Denmark

    Dan Atar, Samir Ali, Frank Steensgaard-Hansen, Kari Saunamäki, Henrik Egeblad & Stig Haunsø

  2. Department of Optics and Fluid Dynamics, Risø National Laboratory, Roskilde, Denmark

    P. S. Ramanujam

Authors
  1. Dan Atar
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  2. Samir Ali
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  3. Frank Steensgaard-Hansen
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  4. Kari Saunamäki
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  5. P. S. Ramanujam
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  6. Henrik Egeblad
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  7. Stig Haunsø
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Additional information

This study was supported by the Danish Heart Foundation. D.A. is a recipient of a travel grant from the Danish Heart Foundation.

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Atar, D., Ali, S., Steensgaard-Hansen, F. et al. The diagnostic value of exercise echocardiography in ischemic heart disease in relation to quantitative coronary arteriography. Int J Cardiac Imag 11, 1–7 (1995). https://doi.org/10.1007/BF01148948

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  • DOI: https://doi.org/10.1007/BF01148948

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