Exercise cross-sectional echocardiographic diagnosis of coronary artery disease.

To test the feasibility of detecting transient left ventricular regional wall motion abnormalities during exercise-induced myocardial ischemia, 55 patients undergoing diagnostic coronary arteriography were studied in a prospective blinded manner with wide angle cross-sectional echocardiography. The ultrasonic studies were obtained with the patients at rest and during exercise in the supine position using a bicycle ergometer. Cross-sectional echocardiographic studies during exercise were adequate for analysis in 43 (78 percent) of the 55 patients. Forty-one of the 43 manifested either a new regional wall motion abnormality during exercise (20 subjects) or wall motion that remained entirely normal during exercise (21 subjects); in two subjects an abnormal wall motion abnormality at rest did not change with exercise. Nineteen of the 20 patients with a new regional wall motion abnormality had significant coronary artery disease and 15 of these 19 had S-T segment depression during bicycle ergometry. The one patient with a normal coronary arteriogram had an early cardiomyopathy. Ten of the 21 subjects with normal wall motion at rest and during exercise had a normal coronary arteriogram, whereas 11 had evidence of important anatomic coronary artery disease and thus had a false negative echocardiographic findings. Six of these 11 patients had S-T segment depression during exercise. The usefulness of exercise echocardiography to predict coronary artery disease was not altered even when only 26 patients without previous myocardial infarction and with a normal cross-sectional echocardiogram at rest were considered. Thus, new regional wall motion abnormalities during exercise as identified with cross-sectional echocardiography represent a specific finding for the presence of coronary artery disease. However, normal regional wall motion during exercise does not exclude the presence of important anatomic coronary artery disease.

Immediate diagnosis of acute myocardial infarction by two-dimensional echocardiography.

To define the role of portable two-dimensional echocardiography (2-D echo) in the immediate diagnosis of acute chest pain syndrome, 80 consecutive patients were studied. Adequate 2-D echo studies were obtained in 65 (81%). Thirty-three patients had clinical evidence of transmural or nontransmural acute myocardial infarction (AMI), 18 of whom had nondiagnostic initial ECGs. Thirty-two did not have a clinical AMI. Thirty-one of the 33 (94%) patients with clinical AMI had regional wall motion abnormalities on the initial 2-D echo; the other two had uncomplicated nontransmural AMIs, diagnosed only by ECG in one and by ECG and moderate elevation of CK-MB isoenzyme in the other. Twenty-seven of the 32 patients without clinical AMI had normal regional wall motion on the initial 2-D echo and none had a complication (severe arrhythmia, recurrent pain, heart failure or death) during the hospital course. Conversely, 10 of the 36 patients with initial 2-D echo regional wall motion abnormalities had a complication (p less than 0.05). Thus, in patients with acute chest pain syndrome, an initial 2-D echo that shows no regional wall motion abnormality suggests that such patients will not develop an AMI or clinical complication during the hospital course. An initial 2-D echo with regional wall motion abnormality identifies a high-risk group of patients who are likely to have AMI and important cardiac complications and may, therefore, benefit from admission to an intensive care unit.