Effects of exercise on the displacement of the atrioventricular plane in patients with coronary artery disease. A new echocardiographic method of detecting reversible myocardial ischaemia

• Published in: European heart journal 1991-07, Vol.12 (7), p.760-765
• Main Authors: Alam, M., Höglund, C., Thorstrand, C., Carlens, P.
• Format: Article
• Language: English
• Subjects: Aged; Atrioventricular plane; Coronary Angiography; coronary artery disease; Coronary Circulation; Coronary Disease - diagnostic imaging; Coronary Disease - physiopathology; Echocardiography; Exercise; Exercise Test; False Negative Reactions; False Positive Reactions; Female; healthy subjects and myocardial ischaemia; Humans; Male; Myocardial Contraction - physiology; Radionuclide Imaging; Sensitivity and Specificity; Thallium Radioisotopes; Ventricular Function - physiology
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/12.7.760

The effect of exercise on the displacement of the atrioventricular (AV) plane was studied by echocardiography (echo) in 48 patients with stable angina pectoris without prior myocardial infarction and 20 age-matched healthy subjects. Echo was performed at rest, immediately after and 10 and 30 min after the test. The patients also underwent thallium stress scintigraphy and coronary angiography. From the apical four- and two-chamber views, the atrioventricular plane displacement (AVPD) during the cardiac cycle was recorded at four sites corresponding to the septal, anterior, lateral and posterior walls of the left ventricle and a mean value was calculated (AV-mean). The healthy subjects and patients had almost the same AVPD at all the sites at rest (AV-mean of 14·5 and 14·2 mm respectively). Immediately post-exercise the healthy subjects showed a significant (P < 0·001) and equally distributed increase in the AVPD at all the sites with an AV-mean value of 19·2 mm. In most of the patients with angiographically confirmed coronary artery disease (CAD), there was a reversible decrease of AVPD (≥3 mm) at one or more of the AV plane sites. The overall sensitivity and specificity were 80% and 100% respectively in identifying CAD patients. The changes correlated well with the reversible ischaemic changes on the thallium scan (sensitivity, 88%, and specificity, 83%). A generalized exercise-induced decrease in AVPD at all the recorded sites had a high specificity (91%) in detecting patients with three-vessel disease. It is concluded that exercise echocardiographic recording of AVPD is a simple and accurate additional non-invasive method for identifying patients with coronary artery disease.