Detection of coronary artery disease in the presence of left ventricular atrophy.

To evaluate the accuracy of exercise echocardiography for the recognition of coronary artery disease in the presence of left ventricular hypertrophy 70 patients were studied. Significant coronary artery disease was present in 25 patients and left ventricular hypertrophy had 29 patients. All patients underwent an exercise ECG and echocardiographic test during which cine-loop digitized echocardiography was obtained. Wall motion was analyzed and a regional wall motion score index was calculated. The overall sensitivities of exercise ECG and echocardiography for detecting coronary artery disease were 60% and 64%, respectively, and the specificities were 49% and 78%, respectively. In patients with left ventricular hypertrophy the specificity of exercise echocardiography was higher (71%) compared to exercise ECG (21%) while in patients without hypertrophy the sensitivity was higher (70% vs. 40%, respectively). Of the 19 patients with a non-diagnostic stress ECG, echocardiography correctly identified 100% of those with coronary artery disease but only 53% of those without disease. It is concluded that exercise digital echocardiography represents a good diagnostic alternative to the exercise ECG for identifying coronary artery disease in the presence of left ventricular hypertrophy and should be useful in patients with a non-diagnostic exercise ECG.