EXERCISE ECHOCARDIOGRAPHY FOR THE EVALUATION OF PATIENTS AFTER NONSURGICAL CORONARY-ARTERY REVASCULARIZATION

Objectives. The purpose of this study was to demonstrate the accuracy of stress echocardiography for detecting the progression of coronary artery disease after nonsurgical revascularization. Background. The expanding role of nonsurgical coronary revascularization procedures mandates the development of sensitive noninvasive techniques for the detection of recurrent ischemia. Methods. Bicycle stress echocardiography was performed in a series of 86 patients 6.5 +/- 1.3 months after a revascularization procedure. Seven patients were excluded from analysis because of poor echocardiographic image quality. Results. Digital analysis achieved a sensitivity of 83% for the entire group and a specificity of 85% for stress echocardiographic detection of significant coronary artery disease. Sensitivity was greater in patients with (88%) than in those without (75%) prior myocardial infarction, but this difference did not reach statistical significance. Additional analysis using an increase in end-systolic volume index or a decrease in ejection fraction during stress as an additional marker for ischemia tended to enhance sensitivity (90% for the entire group and 93% for the subgroup with prior myocardial infarction). Conclusions. Stress echocardiography is a useful and sensitive method for the follow-up of patients undergoing nonsurgical revascularization procedures. The addition of volume determination to routine wall motion analysis may be helpful in patients with prior infarction who have scar tissue that may be difficult to distinguish from an adjacent exercise-induced wall motion abnormality.