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  • Title: [Isoproterenol infusion stress two-dimensional echocardiography in detecting coronary artery disease].
    Author: Ajisaka R, Fujita T, Matsumoto R, Iida K, Ogawa T, Matsuda M, Sugishita Y, Ito I.
    Journal: J Cardiogr; 1983 Dec; 13(4):991-1001. PubMed ID: 6678962.
    Abstract:
    Dynamic exercise two-dimensional (2-D) echocardiography has been utilized as a valuable method in the diagnosis of coronary artery disease (CAD). However, there are some limitations in this technique including inability to apply for patients whose physical capacity is limited. Moreover, appropriate echocardiographic recordings are frequently difficult because of bodily movements and/or hyperventilation during exercise. In order to overcome these limitations, we examined whether isoproterenol (ISP) infusion stress 2-D echocardiography could detect transient LV asynergy or not. The subjects consisted of 19 cases with angina pectoris (AP), 16 with old myocardial infarction (OMI), nine with atypical chest pain syndrome and six with miscellaneous heart disease. ISP stress test was performed prospectively as follows: ISP was infused at a rate of 0.02 microgram/kg/min until anginal pain occurred or significant ST depression (elevation) developed. Real time 2-D echocardiograms were obtained in the short-axis or apical RAO views of the LV before and every one minute during ISP infusion test. Coronary artery stenosis was considered to be present if the narrowing was 50% or more in the luminal diameter. The results were as follows: Adequate echocardiographic recordings were obtained in 86.1% of LV segments at rest, and in 82.2% during ISP infusion. Echocardiographic recordings during ISP infusion were feasible in almost all cases. LV wall motion abnormalities were detected in 12 (86%) of the 14 subjects with OMI and two (29%) of the seven subjects with AP at rest, while induced or exaggerated in nine (64%) of the 14 subjects with OMI and all of the 7 subjects with AP during ISP infusion. On the other hand, LV wall motion remained entirely normal during ISP infusion in 11 (92%) of the 12 subjects without CAD. In 4 (40%) of these 10 subjects without CAD, electrocardiographic judgements were positive in the ISP stress test. None had hazardous arrhythmias or severe anginal pain. ISP infusion stress 2-D echocardiography possessed feasibility of detecting LV wall motion abnormalities because this method could exclude difficulty of recordings due to bodily movements and/or hyperventilation seen in exercise echocardiography. Compared with ISP stress electrocardiography, 2-D echocardiography seemed to be superior with respect to the specificity in detecting CAD. In conclusion, ISP stress echocardiography is a safe and useful method in the diagnosis of CAD.
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