Exercise Echocardiography After Coronary Artery Bypass Grafting Linda J. Crouse, MD, James L. Vacek, MD, Gary D. Beauchamp, MD, Charles B. Porter, MD, Thomas L. Rosamond, MD, and Paul H. Kramer, MD

Exercise echocardiography was used to assess the adequacy of regional myocardial perfuston in 126 patients who had undergone coronary artery bypass grafting. There were 108 men and 17 women (mean age 66 years) evaluated from 6 weeks to 16 years (mean 7 years) after surgery. Resting parasternal long- and short-axis and apical 4- and Z-chamber echocardtograms were recorded, digitized and stored. Maximal, symptom-limited upright treadmill exercise was then performed with monitoring. Rs conunuous e@trocardiographtt peat echocardttgraphic imaghtg and digitization were repeated withht 1 minute of exercise terminatton. Resting and postexercise digitized echocardiograms were compared. A normal regtonal wall motion response to exercise consisted of improved segmental contraction and was used to predict uncompromised regtonal vascular supply. Unimproved or worsened segmental contraction after exercise was abnormal and was used as a predictor of regional vascular insufficiency. All patients underwent cardiac catheterization within 1 month after exercise testing. Regtonal coronary insuftictency was considered to exist when a segment’s major vascular conduit exhibited 160% lumhtal diameter reductton. Compared with the dmultaneousty acquired stress electrocardiogram, exercise echocardiography had superior sensitivity (96 VI 41%), speclfkity (92 vs 67%), posittve predictive value (99 vs 91%), and negative predictive value (66 VI 12%) (p