Comparison of peak and postexercise treadmill echocardiography with the use of continuous harmonic imaging acquisition.

ABSTRACT

OBJECTIVES: We sought to compare the feasibility and accuracy of peak and postexercise treadmill echocardiography with the use of continuous harmonic imaging capture. BACKGROUND: Previous work has demonstrated the superiority of peak exercise echocardiography (EE) as compared with post-EE for the diagnosis of coronary artery disease (CAD). However, most of these studies used fundamental imaging and view-per-view acquisition systems. Technical advantages in stress echocardiography include harmonic imaging and continuous imaging capture. METHODS: The study group included 650 patients (423 men; 60 +/- 12 years) who were submitted to peak and postexercise treadmill echocardiography. RESULTS: Postexercise images were acquired within 55 seconds after exercise (28 +/- 10). The number of segments visualized in each view were similar at peak and post-EE except for the parasternal short-axis view, which was better qualified at postexercise. For analysis of diagnostic capability we included 312 patients 195 were included on the basis of having had an EE and a coronary angiography, whereas 117 patients with pretest probability of CAD < 10% who had atypical chest pain or were asymptomatic were also included and considered as having no CAD. CAD (>/=50% stenosis) was confirmed in 159 patients. Positive EE was defined as ischemia or necrosis. Sensitivity for CAD was higher with peak imaging (92% vs 77%, P <.001), with similar specificity (78% vs 87%, P = not significant) and accuracy (85% vs 82%, P = not significant). CONCLUSION: Peak treadmill EE is technically feasible and has higher sensitivity for CAD than posttreadmill EE. Therefore, in the clinical setting, peak EE should be performed for diagnostic purposes.