Exercise echocardiography performed early and late after percutaneous transluminal coronary angioplasty for prediction of restenosis.

The purpose of this prospective study was to examine the incidence of exercise-induced ischaemia before and after angioplasty as well as 4 months later by exercise echocardiography, to evaluate the prognostic value of exercise echocardiography performed after angioplasty as regards the development of restenosis and to determine whether serial exercise tests increase the accuracy of detecting angiographically relevant restenosis. Fifty patients (39 males; mean age 52 +/- 9 years) without prior Q wave infarction entered the study protocol. Exercise echocardiography was performed 2 days prior to angioplasty, 13 +/- 6 days after successful angioplasty as well as at routine follow-up angiography 3.8 +/- 1.6 months after angioplasty. Angiographically successful angioplasty was achieved in 94% (47150) of patients, and early and late follow-up examinations were performed in all 47 patients. Average luminal diameter stenosis decreased from 65 +/- 5% to 26 +/- 9% immediately after angioplasty. Control angiography showed significant restenosis in 30% (14147) of patients. Exercise echocardiography before angioplasty was positive in 90%, continued to be positive in 30% of patients after angioplasty and was positive in 43% at control angiography. The exercise echocardiogram performed early after angioplasty had an overall accuracy for prediction of restenosis of 70%, with a positive predictive value of 50%, and a negative predictive value of 79%. Sensitivity for detection of restenosis at control angiography was high (86%), but specificity (76%) was moderate. Exercise echocardiograms showing deterioration from 2 weeks to 4 months after angioplasty were taken as a sign of restenosis and resulted in an increased specificity of 94%. Sensitivity, however, decreased to 36%, indicating that some patients with an early positive stress echo had already suffered restenosis 13 days after angioplasty. In conclusion, exercise echocardiography documents improvement in regional function after angioplasty. However, a significant proportion of patients continue to have a positive exercise echocardiogram even though angioplasty was angiographically successful, probably due to persistent ischaemic regions or early restenosis. While exercise echocardiography performed early after angioplasty is of insufficient value for the prediction of restenosis, if performed at late follow-up it has a good diagnostic accuracy for detecting restenosis.