Abstract
The provocation of ST segment depression in response to increased cardiac work is accepted as the simplest and most widely used test for the documentation of myocardial ischemia [1]. These phenomena reflect changes in the polarity of (usually subendocardial) segments, based upon ischemia-induced disturbances in the electrical state of individual myocytes [2], and depend to some extent on the location and extent of ischemia. While the stress electocardiogram (ECG) reflects the electrical manifestation of ischemia, its ability to accurately identify this may be clouded by the development of similar ECG patterns with non-ischemic processes. These influences contrast with the sensitivity and specificity of the mechanical sequelae of ischemia, identified by echocardiography.
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References
Chaitman BR. The changing role of the exercise electrocardiogram as a diagnostic and prognostic test for chronic ischemic heart disease. J Am Coll Cardiol 1986;8:1195–210.
Becker RC, Alpert JS. Electrocardiographic ST segment depression in coronary heart disease. Am Heart J 1988;115:862–868.
Marwick T. Current status of non-invasive techniques for the diagnosis of myocardial ischemia. Acta Clin Belg 1992;47:1–5.
Gianrossi R, Detrano R, Mulvihill D et al. Exercise-induced ST depression in the diagnosis of coronary artery disease: A meta-analysis. Circulation 1989;80:87–98.
Detrano R, Froelicher VF. Exercise testing: Uses and limitations considering recent studies. Prog Cardiovasc Dis 1988;31:173–204.
Bonoris PE, Greenberg PS, Castellanet MJ, Ellestad MH. Significance of changes in R wave amplitudeduring treadmill stress testing: Angiographic correlation. Am J Cardiol 1978;41:846–51.
Kligfield P, Okin PM, Amiesen O, Wallis J, Borer RS. Correlation of the exercise ST/HR slope with anatomic and radionuclide cineangiographic findings in stable angina pectoris. Am J Cardiol 1985;56:418–21.
Myers J, Ahnve S, Froelicher V, Sullivan M. Spatial R wave amplitude changes during exercise: relation with left ventricular ischemia and function. J Am Coll Cardiol 1985;6:603–608.
Quyyumi AA, Raphael MJ, Wright C, Bealing L, Fox KM. Inability of the ST segment/heart rate slope to predict accurately the severity of coronary artery disease. Br Heart J 1984;51:395–398.
Hollenberg M, Budge WR, Wisneski JA, Gertz EW. Treadmill score quantifies electrocardiographic response to exercise and improves test accuracy and reproducibility. Circulation 1980;61:276–285.
Cohn K, Kamm B, Feteih N, Brand R, Goldschlager N. Use of treadmill score to quantify ischemic response and predict extent of coronary disease. Circulation 1979;59:286–296.
Detry J-M, Robert A, Luwaert RJ et al. Diagnostic value of computerized exercise testing in men without previous myocardial infarction. A multivariate compartmental and probabilistic approach. Eur Heart J 1985;6:227–238.
Deckers JW, Rensing BJ, Tyssen JG, Vincke RH, Azar AJ, Simoons ML. A Comparison of methods of analyzing exercise tests for diagnosis of coronary artery disease. Br Heart J 1989;62:438–444.
Morganroth J, Chen CC, David D et al. Exercise cross-sectional echocardiographic diagnosis of coronary artery disease. Am J Cardiol 1981;47:20–26.
Maurer G, Nanda NC. Two dimensional echocardiographic evaluation of exercise-induced left and right ventricular asynergy: Correlation with thallium scanning. Am J Cardiol 1981;48:720–727.
Limacher MC, Quinones MA, Poliner LR, Nelson JG, Winters WL, Waggoner AD. Detection of coronary artery disease with exercise two-dimensional echocardiography. Circulation 1983;67:1211–1218.
Armstrong WF, O’Donnell J, Dillon JC, McHenry PL, Morris SN, Feigenbaum H. Complementary value of two-dimensional exercise echocardiography to routine treadmill testing. Ann Intern Med 1986;105:829–835.
Ryan T, Vasey CG, Presti CF, O’Donnell J, Feigenbaum H, Armstrong WF. Exercise echocardiography: Detection of coronary artery disease in patients with normal left ventricular wall motion at rest. J Am Coll Cardiol 1988;11:993–999.
Galanti G, Sciagra R, Comeglio M et al. Diagnostic accuracy of peak exercise echocardiography in coronary artery disease; Comparison with thallium-201 myocardial scintigraphy. Am Heart J 1991;122:1609–1616.
Crouse LJ, Harbrecht JJ, Vacek JL, Rosamond TL, Kramer PH. Exercise echocardiography as a screening test for coronary artery disease and correlation with coronary arteriography. Am J Cardiol 1991;67:1213–1218.
Marwick T, Nemec J, Pashkow FJ, Stewart WJ, Salcedo EE. Accuracy and limitations of exercise echocardiography in a routine clinical setting. J Am Coll Cardiol 1992;19:74–81.
Ryan T, Segar DS, Sawada SG et al. Detection of coronary artery disease with upright bicycle exercise echocardiography. J Am Soc Echocardiogr 1993;6:186–197.
Hecht HS, DeBord L, Shaw R et al. Digital supine bicycle stress echocardiography: A new technique for evaluating coronary disease. J Am Coll Cardiol 1993;21:950–956.
Upton MT, Rerych SK, Newman GE, Port S, Cobb FR, Jones RH. Detecting abnormalities in left ventricular function during exercise before angina and ST segment depression. Circulation 1980;62:341–349.
Ritchie JL, Trobaugh GB, Hamilton GW et al. Myocardial imaging with thallium-201 at rest and during exercise: Comparison with coronary arteriography and resting and stress electrocardiography. Circulation 1977;56:66–71.
Marwick T, D’Hondt AM, Robert AR et al. Accuracy of multivariate exercise score for coronary disease diagnosis: Comparison with exercise echocardiography and MIBI-SPECT [abstract]. J Am Coll Cardiol 1993;21:160A.
Palac RT, Coombs BJ, Kudenchuk PJ, Crane SK, Murphy ES. Two-dimensional echocardiography during dobutamine infusion — Comparison with exercise testing in evaluation of coronary disease [abstract]. Circulation 1984;70:11–184.
Hoffmann R, Lethen H, Kleinhans E, Flachskampf FA, Hanrath P. Comparison of bicycle and dobutamine stress echocardiography for identification of coronary artery disease [abstract]. Circulation 1991;84:11–476.
Berthe C, Pierard LA, Hiernaux M et al. Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol 1986;58:1167–1172.
Mazieka PK, Nadazdin A, Oakley CM. Dobutamine stress echocardiography fpr detection and assessment of coronary artery disease. J Am Coll Cardiol 1992;19:1203–1211.
Salustri A, Fioretti PR, Pozzoli MMA, McNeill AJ, Roelandt JR. Dobutamine stress echocardiography: its role in the diagnosis of coronary artery disease. Eur Heart J 1992;13:70–77.
Marwick T, D’Hondt A-M, Mairesse G et al. Should patients able to exercise undergo exercise or dobutamine echocardiography? [abstract] Eur Heart J 1993;14:454.
Picano E, Distante A, Masini M, Morales MA, Lattanzi F, L’Abbate A. Dipyridamole echocardiography test in effort angina pectoris. Am J Cardiol 1985;56:452–456.
Picano E, Lattanzi F, Massini M, Distante A, L’Abbate A. High dose dipyridamole echocardiography test in effort angina pectoris. J Am Coll Cardiol 1986;8:848–854.
Masini M, Picano E, Lattanzi F, Distante A, L’Abbate A. High-dose dipyridamole echocardiography test in women: Correlation with exercise-electrocardiography test and coronary arteriography. J Am Coll Cardiol 1988;12:682–685.
Mazeika P, Nihoyannopoulos P, Joshi J, Oakley CM. Uses and limitations of high dose dipyridamole stress echocardiography for evaluation of coronary artery disease. Br Heart J 1992;67:144–149.
Marwick T, D’Hondt AM, Baudhuin T et al. Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: Combination with echocardiography, scintigraphy or both? J Am Coll Cardiol 1993;22:159–167.
Harris CN, Aronow WS, Parker DP, Kaplan MA. Treadmill stress test in left ventricular hypertrophy. Chest 1973;63:353–358.
Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: Anatomic validation of the method. Circulation 1976;55:613–618.
Devereux RB, Alonso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57:450–458.
Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli, WP. Echocardiographic criteria for left ventricular hypertrophy: The Framingham heart study. Am J Cardiol 1987;59:956–960.
Torelli J, Marwick T, Nemec J et al. Influence of left ventricular hypertrophy on the accuracy of exercise echocardiography [abstract]. J Am Coll Cardiol 1992;19:337A.
Sketch MH, Mohiuddin SM, Lynch JD, Zencka AE, Runco V. Significant sex differences in the correlation of electrocardiographic exercise testing and coronary arteriograms. Am J Cardiol 1975;36:169–173.
Linhart JW, Laws JG, Satinsky JD. Maximum treadmill exercise electrocardiography in female patients. Circulation 1974;50:1173–1178.
Detry J-M, Kapita BM, Cosyns J, Sottiaux B, Brasseur LA, Rousseau MF. Diagnostic value of history and maximal exercise electrocardiography in men and women suspected of heart disease. Circulation 1977;56:756–761.
Hung J, Chaitman BR, Lam J et al. Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women: A multivariate comparison of cardiac fluoroscopy, exercise electrocardiography and exercise thallium myocardial perfusion scintigraphy. J Am Coll Cardiol 1984;4:8–16.
Melin JA, Wijns W, Vanbutsele RJ et al. Alternative diagnostic strategies for coronary artery disease in women: Demonstration of the usefulness and efficiency of probability analysis. Circulation 1985;71:535–542.
Robert AR, Melin JA, Detry J-M. Logistic discriminant analysis improves diagnostic accuracy of exercise testing for coronary artery disease in women. Circulation 1991;83:1202–1209.
Massini M, Picano E, Lattanzi F, Distante A, L’Abbate A. High-dose dipyridamole echocardiography test in women: Correlation with exercise electrocardiography test and coronary arteriography. J Am Coll Cardiol 1988;12:682–685.
Sawada SG, Ryan T, Fineberg NS et al. Exercise echocardiographic detection of coronary artery disease in women. J Am Coll Cardiol 1989;14:1440–1447.
Coma-Canella I. Sensitivity and specificity of dobutamine-electrocardiography test to detect multivessel disease after acute myocardial infarction. Eur Heart J 1990;11:249–257.
Coma-Canella I. Dobutamine stress test to diagnose the presence and severity of coronary lesions in angina. Eur Heart J 1991;12:1198–1204.
Sawada SG, Segar DS, Ryan T et al. Echocardiographic detection of coronary artery disease during dobutamine infusion. Circulation 1991; 83:1605–1614.
Cohen JL, Greene TO, Ottenweller J, Binenbaum SZ, Wilchfort SD, Kim CS. Dobutamine digital echocardiography for detecting coronary artery disease. Am J Cardiol 1991; 67:1311–1318.
Marcowitz P, Armstrong WF. Accuracy of dobutamine stress echocardiography in detecting coronary artery disease. Am J Cardiol 1992;69:1269–1273.
Mairesse G, Marwick T, D’Hondt AM, Wyns W, Melin JA, Detry J-M. How reliable is the dobutamine stress ECG for the diagnosis of coronary disease? A Receiver Operating Curve analysis [abstract]. J Am Coll Cardiol 1993;21:174A.
Picano E, Lattanzi F, Masini M, Distante A, L’Abbate A. Usefulness of the dipyridamole-exercise echocardiography test for diagnosis of coronary artery disease. Am J Cardiol 1988;62:67–70.
Cohen JL, Greene TO, Alston JR, Wilchford SD, Kim CS. Usefulness of oral dipyridamole digital echocardiography for detecting coronary artery disease. Am J Cardiol 1989;64:385–386.
Agati L, Arata L, Peraldo Neja C et al. Usefulness of the dipyridamole-Doppler test for diagnosis of coronary artery disease. Am J Cardiol 1990;65:829–834.
Marwick T, Willemart B, D’Hondt AM et al. Selection of the optimal non-exercise stress for the evaluation of ischemic regional myocardial dysfunction and malperfusion: Comparison of dobutamine and adenosine using echocardiography and Tc-99 m MIBI single photon emission computed tomography. Circulation 1993;87:345–354.
Zoghbi WA, Cheirif J, Kleiman NS, Verani MS, Trakhtenbroit A. Diagnosis of ischemic heart disease with adenosine echocardiography. J Am Coll Cardiol 1991;18:1271–1298.
Picano E. Dipyridamole-echocardiography test: Historical background and physiologic basis. Eur Heart J 1989;10:365–376.
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© 1994 Springer Science+Business Media Dordrecht
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Marwick, T., Detry, JM. (1994). Comparison of Exercise and Pharmacologic Stress Echocardiography and Electrocardiography. In: Stress Echocardiography. Developments in Cardiovascular Medicine, vol 149. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-0782-2_6
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DOI: https://doi.org/10.1007/978-94-011-0782-2_6
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