|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 1994; 24:117-124 © 1994 by the American College of Cardiology Foundation |
Institute of Cardiology, University of Bari, Italy.
OBJECTIVES. This study assessed and compared the diagnostic potential of exercise, transesophageal atrial pacing and dipyridamole stress echocardiography in a clinical setting. BACKGROUND. Although they have been widely studied, no data exist with regard to comparisons of these procedures in a head-to-head study in different clinical settings. METHODS. One hundred four consecutive patients with suspected coronary artery disease undergoing coronary angiography and with no previous myocardial infarction or rest left ventricular wall motion abnormalities underwent digital posttreadmill, transesophageal atrial pacing and dipyridamole echocardiography. RESULTS. Feasibility of digital exercise echocardiography was 84%; 8 of 88 remaining patients had a nondiagnostic exercise echocardiographic test (inadequate exercise or imaging). In 80 patients with feasible and diagnostic digital exercise echocardiography, sensitivity, specificity and accuracy were, respectively, 89%, 91% and 90%. Eighty of the 104 patients underwent transesophageal atrial pacing and dipyridamole echocardiography. Feasibility of the alternative stress procedures was 77% for transesophageal atrial pacing and 96% for dipyridamole. In 60 patients successfully undergoing both alternative stress procedures, sensitivity and specificity were 83% and 76% for atrial pacing and 43% and 92% for dipyridamole echocardiography, respectively. In the group of 24 patients with nondiagnostic exercise echocardiography and consequent indication to alternative stress procedures, accuracy of transesophageal atrial pacing was higher than that of dipyridamole echocardiography (73% vs. 45%, p = 0.06). CONCLUSIONS. Because of its higher diagnostic potential and additional functional information, exercise is the stress of choice when stress echocardiography is used to detect the presence of coronary artery disease. Alternative stresses can be used in patients with nondiagnostic exercise echocardiography. Transesophageal and dipyridamole echocardiography differ in feasibility and diagnostic reliability (higher sensitivity of transesophageal atrial pacing, higher specificity of dipyridamole). These characteristics must be considered when selecting procedures to be used as alternatives to exercise.
This article has been cited by other articles:
|
|
 |
|
  R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC) Eur J Echocardiogr, July 1, 2008; 9(4): 415 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Cheitlin, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, J. L. Davis, P. S. Douglas, D. P. Faxon, L. D. Gillam, T. R. Kimball, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American college of cardiology/American heart association task force on practice guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography) J. Am. Coll. Cardiol., September 3, 2003; 42(5): 954 - 970. [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Cheitlin, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, J. L. Davis, P. S. Douglas, D. P. Faxon, L. D. Gillam, T. R. Kimball, et al. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography) Circulation, September 2, 2003; 108(9): 1146 - 1162. [Full Text] [PDF]
|
|
|
|
|
|
E. Picano, A. Alaimo, V. Chubuchny, E. Plonska, V. Baldo, U. Baldini, M. Pauletti, R. Perticucci, L. Fonseca, H. R. Villarraga, et al. Noninvasive pacemaker stress echocardiography for diagnosis of coronary artery disease: A multicenter study J. Am. Coll. Cardiol., October 2, 2002; 40(7): 1305 - 1310. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Atar, T. Nagai, B. Cercek, T. Z. Naqvi, H. Luo, and R. J. Siegel Pacing stress echocardiography: an alternative to pharmacologic stress testing J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1935 - 1941. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Garber and N. A. Solomon Cost-Effectiveness of Alternative Test Strategies for the Diagnosis of Coronary Artery Disease Ann Intern Med, May 4, 1999; 130(9): 719 - 728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-Y. Lee, P. A. Pellikka, R. B. McCully, D. W. Mahoney, and J. B. Seward Nonexercise stress transthoracic echocardiography: transesophageal atrial pacing versus dobutamine stress J. Am. Coll. Cardiol., February 1, 1999; 33(2): 506 - 511. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Fleischmann, M. G. M. Hunink, K. M. Kuntz, and P. S. Douglas Exercise Echocardiography or Exercise SPECT Imaging?: A Meta-analysis of Diagnostic Test Performance JAMA, September 9, 1998; 280(10): 913 - 920. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
