Bicycle exercise echocardiography in the supine position: a simple and effective study method for the detection and localization of myocardial ischemia by the first consulted cardiologist
Jaussi, A.; Savcic, M.; Delabays, A.; Kappenberger, L.
Praxis 85(31-32): 923-929
1996
ISSN/ISBN: 1661-8157 PMID: 8765721 Document Number: 459945
Exercise echocardiography is increasingly used as an investigative technique, now that dynamic images can be captured digitally. Its equivalent reliability compared to scintigraphic methods has been demonstrated in a hospital setting. This study is an attempt to analyse its impact in daily practise. Standardized progressive stress was provided by bicycle ergometry in a supine position. Echocardiographic images of complete cardiac cycles were obtained in standard apical and parasternal short axial views before, during and after maximum effort and digitized for simultaneous analysis of synchronized images at rest and during exercise. 279 patients were studied (231 men, 48 women, mean age 61 +/- 10 years). Image quality was suboptimal in four cases. In the remaining 275 cases, ischemia was detected in 125 cases, the test was negative in 141 cases and doubtful in nine cases. Control by selective coronary angiography, as motivated by the clinical situation, was performed in 72 cases. In this particular group, exercise echocardiography showed 89% sensitivity, which is significantly higher than the figure of 63% recorded for conventional exercise testing (p < 0.0001). Exercise echocardiography by bicycle ergometer in a supine position is a valid, noninvasive investigative technique which can be used in an outpatient situation (feasibility 95%), since it is available on the spot. Its value appears greatest in cases where exercise ECG was not conclusive. A negative result enables the first consulted cardiologist to reassure the patient immediately, the favourable prognostic value of such a result having been demonstrated in the literature.