Clinical application of echocardiographic imaging to diagnosis of coronary artery disease

Ergometer two-dimensional echocardiography was performed in 28 subjects complaining of chest pain but without myocardial infarction. Sequential ergometer loading was initiated at 50 or 75 watts, and increased in several stages. Apical four-chamber view two-dimensional echocardiograms were recorded onto video tape, and video images were converted into digital computer signals. After cine-loop display, computer image processing included noise reduction and edge enhancement, M-mode measurements were made at a designated level on the two-dimensional echo images. Wall motion was also analyzed directly from the two-dimensional echo images, using an auto-edge detection method. The derived data were compared with results from coronary angiograms. No echo abnormality was observed at rest, whereas during exercise wall motion was depressed at the diseased site of the angiogram; the amplitude of excursion and the changes in systolic and diastolic velocity were disturbed at the septum in LAD-involved patients, and in the posterolateral wall in both Cx and RCA patients. The imaging success rate using the computer-aided analysis was found to be 92.9%. Sensitivity for diagnosis of coronary artery disease was 82.1% and specificity 89.3%. Ergometer two-dimensional echocardiography with assisted computer image processing appears to be one of the most valuable tools for clinical real time evaluation of coronary artery disease.