Abstract
In hypertension, coronary artery disease (CAD) can be overestimated by stress electrocardiography (ECG) and scintigraphy due to frequent false-positive results. Exercise tests are also limited by an excessive blood pressure increase, and pharmacologic pressure normalization decreases the accuracy of the test. The aim of this study was to assess the accuracy of exercise echocardiography as an alternative test for CAD detection in hypertension, both before and after adequate blood pressure control. We studied 59 hypertensive and 59 normotensive patients undergoing coronary angiography for chest pain. Upright bicycle exercise ECG and echocardiographic tests were performed in each group in the absence of therapy; in hypertensives, the tests were repeated a day apart after blood pressure normalization with sublingual nifedipine. Significant CAD (lumen narrowing > 50%) was detected in 22 hypertensive and 41 normotensive patients. In the two groups, sensitivity, specificity, and diagnostic accuracy of exercise echocardiography performed before treatment were not statistically different (95%, 94%, 94% in hypertensives and 82%, 77%, 83% in normotensives, respectively), but were significantly higher than for the exercise ECG test (68%, 70%, and 69%, respectively). After blood pressure lowering, exercise echocardiography sensitivity slightly decreased (91%), whereas specificity (100%) and diagnostic accuracy (96%) did not vary; on the contrary, exercise ECG sensitivity decreased to 45%. Therefore, according to our data, exercise echocardiography can be an accurate test and more reliable than exercise ECG to detect CAD in normotensives as well as in hypertensives. Normalization of blood pressure with nifedipine does not affect its accuracy, but markedly reduces the sensitivity of exercise ECG. (C) 2000 American Journal of Hypertension, Ltd.
| Original language | English |
|---|---|
| Pages (from-to) | 796-801 |
| Number of pages | 6 |
| Journal | American Journal of Hypertension |
| Volume | 13 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 2000 |
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Keywords
- Exercise echocardiography
- Hypertension
- Nifedipine
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Exercise echocardiography versus exercise electrocardiography in the diagnosis of coronary artery disease in hypertension. / Maltagliati, Anna; Berti, Marco; Muratori, Manuela; Tamborini, Gloria; Zavalloni, Dennis; Berna, Giovanni; Pepi, Mauro.
In: American Journal of Hypertension, Vol. 13, No. 7, 2000, p. 796-801.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Exercise echocardiography versus exercise electrocardiography in the diagnosis of coronary artery disease in hypertension
AU - Maltagliati, Anna
AU - Berti, Marco
AU - Muratori, Manuela
AU - Tamborini, Gloria
AU - Zavalloni, Dennis
AU - Berna, Giovanni
AU - Pepi, Mauro
PY - 2000
Y1 - 2000
N2 - In hypertension, coronary artery disease (CAD) can be overestimated by stress electrocardiography (ECG) and scintigraphy due to frequent false-positive results. Exercise tests are also limited by an excessive blood pressure increase, and pharmacologic pressure normalization decreases the accuracy of the test. The aim of this study was to assess the accuracy of exercise echocardiography as an alternative test for CAD detection in hypertension, both before and after adequate blood pressure control. We studied 59 hypertensive and 59 normotensive patients undergoing coronary angiography for chest pain. Upright bicycle exercise ECG and echocardiographic tests were performed in each group in the absence of therapy; in hypertensives, the tests were repeated a day apart after blood pressure normalization with sublingual nifedipine. Significant CAD (lumen narrowing > 50%) was detected in 22 hypertensive and 41 normotensive patients. In the two groups, sensitivity, specificity, and diagnostic accuracy of exercise echocardiography performed before treatment were not statistically different (95%, 94%, 94% in hypertensives and 82%, 77%, 83% in normotensives, respectively), but were significantly higher than for the exercise ECG test (68%, 70%, and 69%, respectively). After blood pressure lowering, exercise echocardiography sensitivity slightly decreased (91%), whereas specificity (100%) and diagnostic accuracy (96%) did not vary; on the contrary, exercise ECG sensitivity decreased to 45%. Therefore, according to our data, exercise echocardiography can be an accurate test and more reliable than exercise ECG to detect CAD in normotensives as well as in hypertensives. Normalization of blood pressure with nifedipine does not affect its accuracy, but markedly reduces the sensitivity of exercise ECG. (C) 2000 American Journal of Hypertension, Ltd.
AB - In hypertension, coronary artery disease (CAD) can be overestimated by stress electrocardiography (ECG) and scintigraphy due to frequent false-positive results. Exercise tests are also limited by an excessive blood pressure increase, and pharmacologic pressure normalization decreases the accuracy of the test. The aim of this study was to assess the accuracy of exercise echocardiography as an alternative test for CAD detection in hypertension, both before and after adequate blood pressure control. We studied 59 hypertensive and 59 normotensive patients undergoing coronary angiography for chest pain. Upright bicycle exercise ECG and echocardiographic tests were performed in each group in the absence of therapy; in hypertensives, the tests were repeated a day apart after blood pressure normalization with sublingual nifedipine. Significant CAD (lumen narrowing > 50%) was detected in 22 hypertensive and 41 normotensive patients. In the two groups, sensitivity, specificity, and diagnostic accuracy of exercise echocardiography performed before treatment were not statistically different (95%, 94%, 94% in hypertensives and 82%, 77%, 83% in normotensives, respectively), but were significantly higher than for the exercise ECG test (68%, 70%, and 69%, respectively). After blood pressure lowering, exercise echocardiography sensitivity slightly decreased (91%), whereas specificity (100%) and diagnostic accuracy (96%) did not vary; on the contrary, exercise ECG sensitivity decreased to 45%. Therefore, according to our data, exercise echocardiography can be an accurate test and more reliable than exercise ECG to detect CAD in normotensives as well as in hypertensives. Normalization of blood pressure with nifedipine does not affect its accuracy, but markedly reduces the sensitivity of exercise ECG. (C) 2000 American Journal of Hypertension, Ltd.
KW - Exercise echocardiography
KW - Hypertension
KW - Nifedipine
UR - http://www.scopus.com/inward/record.url?scp=0033865388&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033865388&partnerID=8YFLogxK
U2 - 10.1016/S0895-7061(00)00247-8
DO - 10.1016/S0895-7061(00)00247-8
M3 - Article
C2 - 10933572
AN - SCOPUS:0033865388
VL - 13
SP - 796
EP - 801
JO - American Journal of Hypertension
JF - American Journal of Hypertension
SN - 0895-7061
IS - 7
ER -