Stress echocardiography in the detection of @entity741 . Head-to-head comparison of exercise, @entity452 , and XXXX tests.

@entity1 @entity296 @entity452 @entity4341 @entity741 @entity453
BACKGROUND: Exercise and pharmacological stress echocardiography have emerged as convenient alternatives to @entity296 . The objective of this study was to compare in the same @entity1 the diagnostic values of exercise, @entity452 , and @entity4341 stress echocardiography tests for detection of @entity741 . METHODS AND RESULTS: We performed exercise (maximal treadmill Bruce protocol), @entity452 (up to 40 micrograms/kg per minute) and @entity4341 (up to 0.84 mg/kg over 10 minutes) stress echocardiography tests, in random sequence and on separate days, in 136 consecutive @entity1 . All @entity1 underwent coronary angiography. Significant @entity453 was defined by quantitative coronary angiography as a lesion with a diameter stenosis > or = 50%. A stress echocardiogram was considered positive when new or worsening of preexisting wall motion abnormality was observed. Most of the @entity1 (94%) were receiving the same antianginal medication for each stress test; 59 @entity1 were receiving concomitant beta-blocker therapy. The prevalence of @entity453 was 87.5%, with 108 @entity1 having one-vessel @entity453 . Peak heart rate and systolic blood pressure were higher with exercise than with @entity452 or @entity4341 (P < .01). Sensitivity of exercise, @entity452 , and @entity4341 stress echocardiography was 88%, 82%, and 74% ( @entity4341 versus exercise, P < .01), respectively. Specificity was 82%, 77%, and 94%, respectively. The overall accuracy was 87%, 82%, and 77% ( @entity4341 versus exercise, P < .01), respectively. The accuracy of @entity4341 was higher (P = .02) in the group of @entity1 not receiving beta-blockers (84%) than in the @entity1 receiving beta-blocker therapy (66%), whereas the accuracy of exercise and @entity452 were only slightly higher in the @entity1 not receiving beta-blockers. Significant side effects occurred in 3%, 11%, and 1% of @entity1 during exercise, @entity452 , and @entity4341 tests, respectively. CONCLUSIONS: Despite the different hemodynamic effects, exercise, @entity452 , and @entity4341 echocardiography have high overall diagnostic values. In this group of @entity1 with a predominance of one-vessel @entity453 , the overall diagnostic accuracy of stress echocardiography tests was higher for exercise than for @entity452 or @entity4341 . Concomitant beta-blocker therapy significantly decreased the accuracy of the @entity4341 stress echocardiography test. Pharmacological stress testing ( @entity4341 without beta-blockers) can therefore be used as an efficient option for detection of @entity741 in @entity1 who are unable or poorly motivated to exercise adequately.
