Effect of infarcted myocardium on diagnostic accuracy of exercise echocardiography for detecting noninfarct-related coronary artery lesions |
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| Authors: | Nishioka Toshihiko Mitani Hideki Uehata Akimi Hikita Hiroyuki Nagai Tomoo Katsushika Shuichi Takase Bonpei Isojima Kazushige Ohsuzu Fumitaka Kurita Akira Ohtomi Shingo Siegel Robert J |
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| Affiliation: | From the aThird Department of Internal Medicine, Saitama Medical Center, Saitama Medical School, Saitama, bDivision of Cardiology, First Department of Medicine, Self Defense Forces Central Hospital, Tokyo, cFirst Department of Internal Medicine, National Defense Medical College, Saitama, dDivision of Medical Engineering, National Defense Medical College Research Institute, Saitama, Japan, and the eDivision of Cardiology, Cedars-Sinai Medical Center, Los Angeles, Calif. |
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| Abstract: | Background The utility of exercise echocardiography for evaluating remote ischemia due to noninfarct-related artery (n-IRA) lesions in patients with prior myocardial infarction has not been established.Methods Quantitative coronary angiography and treadmill exercise echocardiography were performed within 2 weeks in 115 patients with prior myocardial infarction (>6 weeks) and 224 patients without myocardial infarction. Coronary lumen diameter stenosis ≥50% (by angiography) and the lack of a hyperdynamic response on exercise echocardiography were considered significant. Myocardial infarction size was defined as the number of myocardial segments with severe hypokinesis, akinesis, or dyskinesis on echocardiography at rest.Results For detection of n-IRA lesions in patients with prior myocardial infarction, the sensitivity of exercise echocardiography was similar (78% vs 79%, P = not significant), however, the specificity was significantly lower (77% vs 91%, P < .01) than for detection of significant stenoses in patients without prior myocardial infarction. Angiographic percent-diameter stenosis, presence of collateral vessel, achieved exercise level, and presence of peri-infarct ischemia did not affect the specificity of exercise echocardiography. However, the specificity of exercise echocardiography was significantly lower (69% vs 84%, P < .05) in patients with echocardiographically large infarction (infarction size ≥2) than in patients with small infarction (infarction size <2).Conclusion In patients with prior myocardial infarction, exercise echocardiography showed low specificity for detection of noninfarct-related artery lesions, especially in patients with echocardiographically large myocardial infarction. These characteristics of treadmill exercise echocardiography should be considered when this technique is applied for patients with healed myocardial infarction. (Am Heart J 2003;145:162-8.) |
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