Identification of multivessel coronary artery disease by exercise echocardiography

Objectives. This study examined the ability of exercise echocardiography to identify multivessel coronary artery disease and ascertain its incremental value when combined with clinical and exercise test variables. Background. Although exercise echocardiography has been shown to be accurate for the detection of coronary artery disease, little is known about its utility for identifying multivessel involvement, and its incremental value when combined with clinical and exercise test variables has not been studied. Methods. One hundred fifty consecutive patients were selected on the basis of having had an exercise echocardiographic and a coronary angiographic study within 6 months without any revascularization procedure. Significant coronary artery disease (≥50% diameter stenosis in any major coronary artery) was present in 117 patients, and multivessel (two- or three-vessel) disease was present in 90 patients. The exercise echocardiographic studies were reviewed by an experienced observer unaware of the results of the coronary angiogram. Results. The overall sensitivity and specificity of exercise echocardiography for the identification of multivessel disease were 73% and 70%, respectively. A stepwise logistic regression analysis identified the number of abnormal regions on the postexercise images as the strongest independent predictor of multivessel disease; also significant were a history of myocardial infarction and ST segment depression of at least 2 mm on the peak exercise electrocardiogram. Conclusions. Exercise echocardiography adds independent and incremental information to clinical and exercise test variables for identifying multivessel coronary artery disease.