Comparison of echocardiography at peak exercise and after bicycle exercise in evaluation of patients with known or suspected coronary artery disease.

To determine if echocardiography done immediately after bicycle exercise provides the same information as imaging at peak exercise, we evaluated 104 consecutive patients being studied for coronary artery disease. Interpretable exercise echocardiograms were obtained in 96 patients (92%), 29 of whom had a new wall motion abnormality detected with exercise echocardiography. Of these 29 patients, 10 had a wall motion abnormality detected in apical views obtained during peak exercise that resolved by the time apical imaging was performed after exercise. Three of these 10 patients, however, had wall motion abnormalities in parasternal views taken after exercise in areas adjacent to the wall motion abnormality imaged at peak exercise. The sensitivity of exercise-induced wall motion abnormality for the detection of significant coronary artery disease in those patients undergoing coronary arteriography was 70% for imaging done after exercise versus 100% for imaging done at peak exercise. Six patients' conditions would have been misclassified as normal if only imaging done after exercise had been performed. We conclude that the addition of echocardiographic imaging at peak exercise on a bicycle enhances the sensitivity for the detection of coronary artery disease with exercise echocardiography.