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Conventional isometric stress echocardiography is not routinely used in the assessment of coronary artery disease (CAD) because of low sensitivity in diagnosis of coronary lesions. The purpose of this study was to determine the diagnostic value of a novel approach for detection of CAD: maximal isometric handgrip/emotional stress echocardiography (MIHESE) in patients with suspected CAD compared to conventional dobutamine stress echocardiography (DSE).
197 patients with suspected CAD were studied before coronary angiography: 87 of them underwent MIHESE, 110 – conventional DSE. After baseline measurements by echocardiography at rest, MIHESE patients undertook a handgrip-maneuver with the balloons. The echocardiographic image was monitored throughout the maneuver. The squeezing of the balloons was performed with the both hands and sustained at maximal voluntary contraction for 3 min. The emotional component of stress was performed: the investigator inspired patient to maximal effort during the stress. DSE was performed using standard protocol and took about 40 min. Quantitative coronary angiography served as a reference standard for anatomic disease (significant CAD defined as ≥50% reference diameter).
CAD patients revealed by MIHESE and DSE did not differ in rate of multiple coronary stenoses: 40.4% and 45.5%. MIHESE gave virtually equal sensitivity, 84.5% (95%CL=74.1-94.8) compared to DSE, 87.3% (95%CI=78.3-96.3) and specificity 85.7% (95%CI=71.4-99.7) and 76.6% (95%CI=62.5-90.7), respectively. The positive predictive value of two tests was almost similar: 92.5% (95%CI=84.9-99.8) for MIHESE and 83.3% (95%CI=73.3-93.4) for DSE, as well as the negative predictive value: 72.7% (95%CI=54.5-90.9) for MIHESE and 81.8% (95%CI=69.0-94.7) for DSE. Overall accuracy for MIHESE did not differ from DSE: 84.9% (95%CI=76.5-93.3) and 82.7% (95%CI=74.8-90.7), all p=NS.
MIHESE and DSE have a similar diagnostic value in detection of significant coronary lesions in suspected CAD patients. However, MIHESE is easier to carry out, less time consuming and less expensive compared to DSE. MIHESE may be used as a novel approach for CAD detection.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Mental Stress on the Heart
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1108-63
- 2013 American College of Cardiology Foundation