Supine Bicycle Echocardiography

Objectives The purpose of this work was to assess whether the incorporation of intermediate stages during supine bicycle exercise echocardiography (BEE) improves the accuracy of detection of coronary artery disease (CAD) through the evaluation of a biphasic response. Background Exercise echocardiography allows cardiac imaging throughout exercise. Methods Exercise echocardiography was performed in 104 patients (mean age 57 ± 11 years, 37 women), 91 of whom underwent coronary angiography. The BEE protocol started at 25 W with increments of 25 W every 3-min stage. Images were digitized at rest, 25 W, 50 W, and peak exercise. Two experienced observers and 1 less experienced observer interpreted rest and peak exercise images, with and without the intermediate stages. Results Imaging during intermediate stages improved the sensitivity for detection of all individual vessel stenoses (78% vs. 58%, p 10% predicted CAD (sensitivity 94%, specificity 74%) and was more marked than changes observed from rest to peak exercise. The severity of coronary stenosis related to the double product achieved at the onset of ischemia during exercise (r = −0.61, p Conclusions During BEE, the acquisition and interpretation of intermediate stages of exercise in addition to peak exercise improves the detection of CAD and allows a better physiologic evaluation of the severity of coronary stenosis.