Place of Exercise Echocardiography in Stable Coronary Artery Disease in Sub-Saharan Africa: A Series in Senegal

摘要

Introduction: Exercise echocardiography is a non-invasive technique that occupies a special place for the detection of stable coronary disease. The main objective of this study was to report our experience and assess our practice in the diagnosis of stable coronaryartery disease. Methodology: We conducted a retrospective study, descriptive over a period of 34 months, from December 1, 2016 to September 30, 2019. All the patients received during the study period for stress echocardiography as part of a suspicion of stable coronary artery disease were included. A total of 100 examinations were completed during the study period. Results: Ninety (90) exams were studied. There were 56 men or a sex-ratio of 1.64. The mean age was of 57.3 ± 10 years. Hypertension (31 patients or 62%) was the most frequent risk factor. Typical chest pain was noticed in 45 patients (52.3%). The pre-test probability was intermediate in 77 patients (89.5%). Echocardiography at rest was normal in 86 patients (95.6%). A total of 62 tests were negative (69%) and 02 (2.2%) were non-contributory. Ten tests (10) of 26 electrical positive tests were associated with segmental kinetics disorders. In the 10 patients who had exercise kinetic disorders, 08 had coronary angiography. It was normal in 04 of them. The positive predictive value of exercise echography was 50% in our study. In a patient with a negative exercise echocardiography with a high clinical probability of coronary disease, the coronary angiography showed a two-vessel impairment with an intermediate lesion of Cx2 and an intermediate lesion of RCA2. It thus constitutes a false negative. Sensitivity was 80% in our study. We noticed an incident like non-sustained ventricular tachycardia. Conclusion: Exercise echocardiography is a safe and reliable examination for the diagnosis of stable coronary artery disease. A good selection of patients based on the clinical probability of coronary ischemia should improve our sensitivity. This is even more important in sub-Saharan Africa, where access to coronary angiography is limited.