Accuracy and cost-effectiveness of exercise echocardiography for detection of coronary artery disease in patients with mitral valve prolapse

American Heart Journal
D Y LeungT H Marwick

Abstract

Mitral valve prolapse is sometimes associated with chest pain, but this symptom may also be caused by coexisting coronary disease. The accuracy of exercise echocardiography in diagnosing coronary disease in these patients and the most cost-efficient diagnostic approach are unclear. We studied 96 patients (aged 59 +/- 12 years; 70 men) with mitral valve prolapse who underwent exercise electrocardiography, exercise echocardiography, and coronary angiography. The accuracies of seven diagnostic strategies based on the current and expected use of exercise electrocardiography and exercise echocardiography in patients with mitral valve prolapse were examined, with the costs calculated based on Medicare reimbursement. Thirteen (13.5%) patients had significant coronary artery disease. The sensitivity and specificity of exercise electrocardiography in the 71 patients with interpretable electrocardiograms were 50% and 72%, respectively. For the 73 patients who achieved >85% of maximal heart rate, 52 had interpretable exercise electrocardiograms (sensitivity 50%; specificity 69%). Exercise echocardiography had a sensitivity of 69% and a specificity of 98% in the 96 patients and a sensitivity of 82% and a specificity of 96% in patients who ...Continue Reading

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Citations

Feb 12, 2005·Lancet·Emil HayekBrian P Griffin
Jun 27, 2007·Radiology·Joseph C WuSanjiv S Gambhir
Nov 30, 2000·Current Treatment Options in Cardiovascular Medicine·C R Asher, W J Stewart
Jun 23, 2001·The American Journal of the Medical Sciences·W JacobsG A Stouffer
Sep 14, 2007·Scandinavian Journal of Clinical and Laboratory Investigation·O E Johansen
Sep 25, 2003·Heart Disease·Glenn Gandelman, Monty M Bodenheimer
Mar 15, 2000·Coronary Artery Disease·G P Armstrong, B P Griffin
Sep 5, 2001·Clinical Endocrinology·B L HerrmannK Mann

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