DUAL UTILIZATION OF EXERCISE ECHOCARDIOGRAMS AND MYOCARDIAL PERFUSION IN ASSESSING ISCHEMIA IN A CARDIOLOGY PRACTICE


Yzhar Charuzi, M.D., Cedars Sinai Heart Institute, Los Angeles, CA, USA

In patients with suspected ischemia, the data derived from one type of imaging test may be insufficient to assess its significance. In 62 patients, two imaging techniques were utilized to assess the extent of ischemia and help determine clinical management. 130 dual studies consisting of both a myocardial perfusion test (MPT) and an exercise echocardiogram (EXE) were performed on the same 62 patients. The median patient age was 68, and ninety-one percent were male. The tests were conducted within two months of each other. Myocardial perfusion was evaluated by exercise SPECT, adenosine SPECT, or a PET scan. EXEs were performed by using a treadmill and BRUCE protocol and imaging before and immediately after exercise. Ischemia by perfusion not associated with exercise wall motion abnormalities was considered mild. If ischemia was seen with both techniques, it was considered significant and handled appropriately. Fifty-five percent of the MPTs and thirty-five percent of the EXEs were abnormal. In approximately twenty-three percent of the dual studies, a positive MPT was not associated with wall motion abnormalities in the EXE, thus leaving the diagnosis of ischemia open. In conclusion, dual imaging is a useful tool to determine the true extent of ischemia in a cardiology practice.