Dr Carlos Charlante email: Charlante@movi.com.ar
The purpose of this study was to determine if exercise echo (ExE) could add sensitivity, specificity and overall accuracy to exercise ECG (ExECG) in the detection of coronary artery disease (CAD) in patients who performed either a maximal and submaximal exercise..
A consecutive group of 43 patients (age 57.7 +/- 11.6) (30 males), underwent ExE (treadmill) and coronary angiography.
A positive ExECG was defined as > 0.1 mV ST depression, and positive ExE was defined by a new or worsening wall motion abnormality. Significant disease was defined as stenosis greater than 70 %.
| Submax Ex.ECG | Submax Ex.echo | P value | Max. Ex.Ecg | Max. Ex.echo | P Value | |
|---|---|---|---|---|---|---|
| SENSITIVITY | 38% | 94% | less than 0.0004 | 50% | 100% | less than 0.01 |
| SPECIFICITY | 80% | 100% | 0.25 | 79% | 67% | 0.7 |
| ACCURACY | 48% | 95% | less than 0.0006 | 68% | 77% | 0.2 |
| PV POSITIVE | 86% | 100% | 0.25 | 57% | 58% | 0.4 |
| PV NEGATIVE | 29% | 83% | less than 0.0009 | 73% | 100% | 0.06 |
ExE demonstrated greater sensitivity than ExECG in both maximal and submaximal populations. Specificity was statistically non significant in both subgroups. Accuracy was enhanced in the submaximal cohort. The negative predictive value was significantly superior in the ExE submaximal population.
1) Exercise Echocardiography was more accurate than Exercise ECG in detection of CAD in patients who performed a submaximal test.
2) The Sensitivity of Exercise Echo was superior to ExECG in the maximal subgroup but there were no significant differences in neither specificity nor accuracy