Use of the epinephrine test in diagnosis of coronary artery disease

Two-dimensional echocardiographic (2-D echo) and electrocardiographic (ECG) monitoring was performed in 53 patients with anginal chest pain during infusion of physiologic doses of epinephrine. Technically adequate 2-D echo studies were recorded in 45 patients. Of these 45 patients, 35 had significant coronary artery disease. Twenty-two patients showed ECG changes during the test (ECG sensitivity 63%), 13 of whom also showed wall motion abnormalities (2-D echo sensitivity 48.5%). Combined ECG and 2-D echo criteria of a positive test yielded a sensitivity of 74%. None of the 10 patients without coronary artery disease had electrical or mechanical abnormalities during the test (specificity 100%). Thus, the epinephrine test during simultaneous 2-D echo and ECG monitoring is a valid alternative to echocardiographic exercise stress testing. Furthermore, the adequate images obtained during the infusion allow better investigation of relation between wall motion abnormalities and ECG changes during myocardial ischemia.