Myocardial Stunning After Exercise Testing in Coronary Artery Disease

To determine the presence of "myocardial stunning" and to identify its relative value in the diagnosis of coronary artery disease (CAD), resting electrocardiographic and echocardiographic examinations were performed in 47 cases (with 44 males, mean age 56±8 years) admitted with typical and atypical angina pectoris, postinfarction angina and nonanginal chest pain. This was followed by recording of echocardiographic images immediately after the bicycle exercise testing and at the 15th and 30th minutes to determine whether persistent left ventricular wall motion abnormalities had developed as compared to the pre-exercise period. Wall motions were scored as 1: normal, 2: hypokinetic, 3: akinetic, 4: dyskinetic. Coronary angiograms were then performed in all patients. In 30 of 35 patients (85,7%) in whom CAD was found by coronary angiography, significant increases in the wall motion scores of all left ventricular regional walls were found immediately after exercise compared with resting values (p<0,01 -p<0.0005). The score rise continued significantly 15 and 30 minutes after exercise (p<0,0005 and p<0,0005, respectively). Localisation of the narrowings found by coronary angiography was related with the wall motion changes. We concluded that exercise echocardiography is a reliable noninvasive test (cheaper than invasive techniques) which provides valuable information on the existence, extent and intensity of CAD and myocardial stunning.