Left ventricular myocardial and cavity velocity disturbances are powerful predictors of significant coronary artery stenosis
No Thumbnail Available
Authors
Bytyci, I
Alves, L
Alves, O
Lopes, C
Issue Date
2022
Type
Scientific Paper
Language
Keywords
Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Cardiology
Alternative Title
Abstract
Background and Aim: Dobutamine stress echocardiography (DSE) is a well-established noninvasive investigation for significant coronary artery disease (CAD). The aim of this study was to evaluate the accuracy of cardiac Doppler parameters in predicting CAD. Methods: We prospectively studied 103 consecutive patients with suspected CAD based on typical symptoms; 59 proved to have CAD, and 44 patients proved to have no-CAD (n = 44). All patients underwent a complete stress Doppler echocardiographic examination. Total isovolumic time (T-IVT) as a marker of cavity dyssynchrony and wall motion score index (WMSI) were also calculated. Results: At peak dobutamine stress, the compromised LV longitudinal excursion (MAPSE), systolic septal and lateral velocities (s’), and diastolic indices were more pronounced in the CAD patients compared with those without CAD, but LV dimension did not differ between groups (p > 0.05). The WMSI was higher and t-IVT more prolonged in patients with CAD (p < 0.01 for both). Similarly, the changes were more pronounced in patients with significant CAD compared with insignificant CAD. On multivariate model, Δ mean s’, OR 2.016 (1.610 to 3.190; p < 0.001), Δ E velocity OR 2.502 (1.179 to 1.108; p < 0.001), Δ t-IVT 2.206 (1.180 to 2.780; p < 0.001) and Δ WMSI OR 1.911 (1.401 to 3.001; p = 0.001) were the most powerful independent predictors of the presence of CAD, particularly when significant (>75%). Δ mean s’ < 5.0 was 85% sensitive, 89% specific with AUC 0.92. Respective values for Δ E velocity <6.0 cm/s were 82%, 90% and 0.91; for Δ t-IVT > 4.5, 78%, 77% and 0.81 and for Δ FT ≥ 150 ms, 76%, 78% and 0.84 in predicating significant CAD. WMSI ≥ 0.7 was 75% sensitive, 77% specific with AUC of 0.81 in predicting significant CAD. The accuracy of DSE was higher in significant CAD compared to insignificant CAD (80% vs. 74%; p = 0.03). Conclusions: Compromised LV longitudinal systolic function, lower delta E wave, prolonged t-IVT, and increased WMSI were the most powerful independent predictors of the presence and significance of CAD. These finding strengthen the role of comprehensive DSE analysis in diagnosing ischemic disturbances secondary to significant CAD.
Keywords: dobutamine stress echocardiography; insignificant coronary artery disease; suspected coronary artery disease.
PubMed Disclaimer
Conflict of interest statement
The authors have no conflict of interest to declare.
Figures
Figure 1
Figure 1 Clinical predictors of significant CAD.…
Figure 2
Figure 2 Echocardiographic predictors of significant CAD.…
Figure 3
Figure 3 ROC analysis of echocardiographic predictors.…
Similar articles
Longitudinal myocardial function is more compromised in cardiac syndrome X compared to insignificant CAD: Role of stress echocardiography and calcium scoring.
Bytyçi I, Bengrid TM, Henein MY.
Clin Physiol Funct Imaging. 2022 Jan;42(1):35-42. doi: 10.1111/cpf.12733. Epub 2021 Nov 12.
PMID: 34716983
Feasibility of myocardial performance index for evaluation of left ventricular function during dobutamine stress echocardiography before and after coronary artery bypass grafting.
Hashemi N, Samad BA, Hedman A, Brodin LÅ, Alam M.
Echocardiography. 2014 Sep;31(8):989-95. doi: 10.1111/echo.12488. Epub 2013 Dec 20.
PMID: 24354348 Clinical Trial.
Long-term prognostic impact of dobutamine stress echocardiography in patients with Kawasaki disease and coronary artery lesions: a 15-year follow-up study.
Noto N, Kamiyama H, Karasawa K, Ayusawa M, Sumitomo N, Okada T, Takahashi S.
J Am Coll Cardiol. 2014 Feb 4;63(4):337-44. doi: 10.1016/j.jacc.2013.09.021. Epub 2013 Oct 16.
PMID: 24140657
Tissue velocity imaging with dobutamine stress echocardiography--a quantitative technique for identification of coronary artery disease in patients with left bundle branch block.
Badran HM, Elnoamany MF, Seteha M.
J Am Soc Echocardiogr. 2007 Jul;20(7):820-31. doi: 10.1016/j.echo.2007.01.007.
PMID: 17617308
Stress echocardiography: abnormal response of tissue Doppler-derived indices to dobutamine in the absence of obstructive coronary artery disease in patients with chronic renal failure.
Jassal DS, Neilan TG, Picard MH, Wood MJ.
Echocardiography. 2007 Jul;24(6):580-6. doi: 10.1111/j.1540-8175.2007.00455.x.
PMID: 17584197 Clinical Trial.
See all similar articles
Cited by
Strain Rate Changes during Stress Echocardiography Are the Most Accurate Predictors of Significant Coronary Artery Disease in Patients with Previously Treated Acute Coronary Syndrome.
Shenouda R, Bytyçi I, El Sharkawy E, Hisham N, Sobhy M, Henein MY.
Diagnostics (Basel). 2023 May 19;13(10):1796. doi: 10.3390/diagnostics13101796.
PMID: 37238281 Free PMC article.
The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology.
Nicolosi GL.
J Clin Med. 2022 Nov 30;11(23):7095. doi: 10.3390/jcm11237095.
PMID: 36498670 Free PMC article.
References
Detrano R., Gianrossi R., Froelicher V. The diagnostic accuracy of the exercise electrocardiogram: A meta-analysis of 22 years of research. Prog. Cardiovasc. Dis. 1989;32:173–206. doi: 10.1016/0033-0620(89)90025-X. - DOI - PubMed
Senior R., Monaghan M., Becher H., Mayet J., Nihoyannopoulos P., British Society of Echocardiography Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: A critical appraisal. Supported by the British Society of Echocardiography. Heart. 2005;91:427–436. doi: 10.1136/hrt.2004.044396. - DOI - PMC - PubMed
Heijenbrok-Kal M.H., Fleischmann K.E., Hunink M.G. Stress echocardiography, stress single-photon-emission computed to-mography and electron beam computed tomography for the assessment of coronary artery disease: A meta-analysis of diag-nostic performance. Am. Heart J. 2007;154:415–423. doi: 10.1016/j.ahj.2007.04.061. - DOI - PubMed
Agarwal V., Yao S.-S., Chaudhry F.A. Utilization of stress echocardiography in patients with multivessel coronary artery disease. J. Cardiovasc. Med. 2016;17:354–360. doi: 10.2459/JCM.0000000000000298. - DOI - PubMed
Armstrong W.F., Zoghbi W.A. Stress echocardiography: Current methodology and clinical applications. J. Am. Coll. Cardiol. 2005;45:1739–1747. doi: 10.1016/j.jacc.2004.12.078. - DOI - PubMed
Description
Citation
Bytyçi I, Alves L, Alves O, Lopes C, Bajraktari G, Henein MY. Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis. J Clin Med. 2022 Oct 20;11(20):6185. doi: 10.3390/jcm11206185. PMID: 36294506; PMCID: PMC9605655.