Predischarge exercise echocardiography in patients with unstable angina who respond to medical treatment

Open Access
Publisher Website
Google Scholar
Abstract
The diagnostic and prognostic value of predischarge exercise echocardiography (echo) was assessed prospectively in 36 patients with unstable angina soon after stabilization on medical treatment. Two‐dimensional echo was performed at rest and immediately after a symptom‐limited exercise test. Patients with previous myocardial infarction, coronary revascularization, left bundle‐branch block and dilated cardiomyopathy were excluded. Left ventricular regional wall motion was analyzed visually and a wall motion score index (WMSI) was derived. Patients were followed prospectively for an average period of 26 months (range 16–34 months). The study end points were a new cardiac event defined as acute myocardial infarction or a need for coronary revascularization because of a recurrence of severe medically refractory angina. Sixteen patients (44%) had positive exercise electrocardiography (ECG), while exercise echo was positive in 22 patients (61%). Of 28 patients undergoing coronary angiography, 23 had significant coronary artery disease (CAD). The sensitivity of exercise ECG in detecting CAD was 61% while the corresponding result was 83% for exercise echo. Cardiac events occurred in 21 patients (58%). Exercise ECG was positive in 12 of these patients (57%), while a positive exercise echo was found in 17 patients (81%). There were significantly more patients with positive exercise echo among patients experiencing cardiac events than among those without cardiac events (p<0.01). In patients with CAD, WMSI decreased significantly after exercise (p<0.05). Exercise WMSI was also significantly lower in patients with CAD than in those without CAD (p<0.02). Exercise WMSI also discriminated patients with cardiac events from those without such events (p < 0.01). Thus predischarge exercise echo is highly sensitive in detecting significant CAD and in identifying subsequent cardiac events in patients with unstable angina stabilized on medical treatment.