Document Detail

Effect of infarcted myocardium on diagnostic accuracy of exercise echocardiography for detecting noninfarct-related coronary artery lesions.
MedLine Citation:
PMID:  12514669     Owner:  NLM     Status:  MEDLINE    
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 > or =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 > or =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.
Toshihiko Nishioka; Hideki Mitani; Akimi Uehata; Hiroyuki Hikita; Tomoo Nagai; Shuichi Katsushika; Bonpei Takase; Kazushige Isojima; Fumitaka Ohsuzu; Akira Kurita; Shingo Ohtomi; Robert J Siegel
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  145     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-06     Completed Date:  2003-03-06     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  162-8     Citation Subset:  AIM; IM    
Third Department of Internal Medicine, Saitama Medical Center, Saitama Medical School, Kawagoe, Saitama, Japan.
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MeSH Terms
Coronary Angiography
Coronary Disease / complications,  diagnosis*
Exercise Test*
Middle Aged
Myocardial Infarction / complications*
Risk Factors
Sensitivity and Specificity

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