Supine Bicycle EchocardiographyImproved Diagnostic Accuracy and Physiologic Assessment of Coronary Artery Disease With the Incorporation of Intermediate Stages of Exercise
Tae-Ho Park, MD,
Nawar Tayan, MD,
Kimiko Takeda, MD,
Hui-Kyung Jeon, MD,
Miguel A. Quinones, MD, FACC and
William A. Zoghbi, MD, FACC*
Department of Cardiology, The Methodist Hospital, Houston, Texas; and The Methodist DeBakey Heart Center Imaging Institute, Houston, Texas.
View larger version (64K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 Protocols of Interpretation of Rest, Intermediate Stages, and Peak Exercise and the Process of Blinding the Intermediate Stages
Still images (and Online Videos) in the 2-chamber view at end-systole from a patient who was interpreted as having right coronary artery ischemia with bicycle exercise echocardiography without intermediate-stage images and as having, in addition, left anterior descending coronary artery ischemia with bicycle exercise echocardiography with intermediate stage. Note the smallest left ventricular end-systolic volume at 50 W (stage II) and the left ventricular dilatation at peak. This and the anterior ischemia are not as obvious if rest (R) and peak (P) images were only displayed.
Please see the Appendix for accompanying videos.
|
|
View larger version (18K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 Impact of Imaging Protocol on Diagnostic Accuracy of BEE
Comparative diagnostic accuracy between rest-peak protocol (R-P) (open bars) and rest-intermediate stages-peak protocol (solid bars) during bicycle exercise echocardiography (BEE) in the detection of all vessels. *p < 0.05 versus R-P.
|
|
View larger version (21K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3 Changes in Interpretation of BEE With Incorporation of Intermediate Stages of Exercise
Individual changes in interpretation of bicycle exercise echocardiography (BEE) between the 2 protocols are shown. R-P = rest-peak protocol; R-I-P = rest-intermediate stages-peak protocol.
|
|
View larger version (17K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 4 Receiver-Operator Curves of Changes in LVESV During BEE and Detection of CAD
Graphs showing sensitivity and specificity according to various cutoff values of percent change of left ventricular end-systolic volume (LVESV) for the detection of coronary artery disease (CAD). (Left) Percent change in LVESV from baseline to peak stage. (Right) Percent change from smallest LVESV in intermediate stages to peak exercise (Ex). AUC = area under the curve; BEE = bicycle exercise echocardiography.
|
|
View larger version (14K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 5 Double Product at the Occurrence of Ischemia Versus Percent Coronary Stenosis
Correlation between double product of systolic blood pressure and heart rate at the occurrence of ischemia and percent diameter stenosis in the 34 patients with left anterior descending coronary artery (LAD) stenosis and 38 patients with non-LAD stenosis.
|
|
|
