Exercise cross-sectional echocardiography in ischemic heart disease.

Abstract

SUMMARY We performed cross-sectional echocardiograms at rest, during supine bicycle exercise, and after sublingual nitroglycerin administration in 28 patients suspected of having ischemic heart disease. Technically adequate exercise cross-sectional echocardiograms were obtained in 20 patients (71%). Ten patients had new areas of reversible segmental dysynergy, and all 10 had significant stenoses of coronary arteries supplying areas of the heart corresponding to the location of reversible dysynergy. Six of these 10 patients also underwent exercise thallium-201 perfusion scanning, and all six had reversible perfusion defects in the area that demonstrated reversible dysynergy on exercise cross-sectional echocardiography. At least two of the remaining 10 patients who did not have reversible segmental dysynergy on exercise cross-sectional echocardiography probably experienced myocardial ischemia that we did not detect. We conclude that exercise cross-sectional echocardiography is technically difficult but feasible. The mechanical consequences of exercise-induced regional myocardial ischemia can be detected noninvasively by real-time, two-dimensional, cross-sectional echocardiography.REGIONAL left ventricular dysfunction is a hallmark of ischemic heart disease. Segmental left ventricular contraction abnormalities occur within a few seconds after onset of acute myocardial infarction, and appear transiently during episodes of reversible myocardial ischemia. Noninvasive detection of these mechanical consequences of myocardial ischemia and infarction should improve our ability to diagnose and enhance our understanding of coronary heart disease.From the

Evaluation of left ventricular function during upright exercise: correlation of exercise Doppler with postexercise two-dimensional echocardiographic results.

“…This is similar to the 75% to 90% rate of acceptable studies obtained by other authors. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] When the criteria of percentage change in peak ejection velocity of less than 85% or an absolute value for peak ejection velocity of 1.1 m/sec at maximal exercise is used, subjects with normal left ventricular function may be differentiated from patients with significant coronary artery disease and ischemic left ventricular dysfuntion. Further study is necessary to evaluate the changes in peak ejection velocity in patients with congestive cardiomyopathy and those with left ventricular dysfunction at rest.…”

“…2, 413-419, 1987. RECENT STUDIES have shown that pulsed Doppler velocity measurements can accurately estimate stroke volume and cardiac output at rest. [1][2][3][4][5] In addition, the technique is reported to reflect changes in blood flow during exercise in normal subjects.`However, little data are available that assess the Doppler-derived variables of aortic flow during exercise in patients with coronary artery disease.9'-Two-dimensional echocardiography has been shown to increase the sensitivity of exercise testing in the detection of coronary artery disease when used either during [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] or immediately after exercise18-20 by demonstrating the percent changes in both global and segmental left ventricular function.…”

Echocardiographic assessment of myocardial ischemia

“…In the last 35 years, since one of the first descriptions of twodimensional stress echocardiography (2D-SE) by Wann et al (44), 2D-SE has considerably developed. This method is cost effective, safe and free of non-ionizing radiation (32).…”

Assessment of ischemia by using dobutamine stress echocardiography test in patients with isolated ST depression in inferior leads demonstrated during channel treadmill exercise electrocardiography test

“…24 Ancak, özellikle hiperpne nedeni ile yeterli ekokardiyografi görüntü-sünün alınamaması bu testi teknik olarak zorlaştır-mıştır. Son yıllarda geliştirilen stres ekokardiyografi bu kısıtlamaları ortadan kaldırmıştır.…”