Does chest shape influence exercise stress echocardiographic results in patients with suspected coronary artery disease?

Sonaglioni, Andrea; Nicolosi, Gian Luigi; Rigamonti, Elisabetta; Lombardo, Michele; Gensini, Gian Franco; Ambrosio, Giuseppe

doi:10.1007/s11739-021-02773-1

Cited by 11 publications

(15 citation statements)

References 43 publications

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“…The prevalence of FP stress echocardiographic results detected in our cohort of patients (24.1%) was similar to that observed in our previous investigation (19.4%) 14 and to that detected by other authors 25 …”

Section: Discussionsupporting

confidence: 92%

“…Differently from our previous investigation in which we specifically focused on 160 patients with positive ESE result enrolled over a period of almost 6 years, 14 the present study provided a comprehensive evaluation of a retrospective series of 1275 patients who had undergone ESE for suspected CAD over a longer period (approximately 10 years), regardless of ESE results.…”

Section: Discussionmentioning

confidence: 99%

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Modified Haller index is inversely correlated with true positive exercise stress echocardiographic results

Sonaglioni

Nicolosi²,

Rigamonti

et al. 2022

Journal of Cardiovascular Medicine

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Aims The influence of chest wall shape on exercise stress echocardiography (ESE) results has been poorly investigated. We aimed at evaluating the main predictors of true positive (TP)-ESE in a population of subjects with suspected coronary artery disease (CAD), categorized according to chest wall conformation, assessed by modified Haller index (MHI, chest transverse diameter over the distance between sternum and spine).Methods All consecutive patients with suspected CAD referred to our EchoLab for performing ESE between September 2011 and October 2021 were retrospectively enrolled. Preliminary assessment of both pretest probability (PTP) and MHI was performed. All patients with positive ESE underwent coronary angiography. Obstructive CAD was diagnosed by > -70% stenosis in any epicardial coronary artery. Outcome was TP-ESE result.Results 1275 consecutive patients (64.9 W 13.0 years) entered the study. Subjects with concave-shaped chest wall (MHI > 2.5) (10.7%) and those with normal chest shape (MHI < -2.5) (89.3%) were separately analyzed. PTP was similar in both groups (21.8 W 13.2 vs. 23.5 W 13.3%, P U 0.15). One hundred and seventy patients were diagnosed with positive ESE: 129 (75.9%) had obstructive CAD (TP), whereas the remaining 41 (24.1%) had no CAD. Only 2.3% of TP-ESE was detected in subjects with MHI >2.5. PTP (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.04), dyslipidemia (OR 4.37, 95% CI 2.81-6.80), dyssynergy in the left anterior descending territory (OR 8.21, 95% CI 5.07-13.3) were linearly correlated to TP-ESE, whereas MHI >2.5 (OR 0.25, 95% CI 0.14-0.67) was inversely associated to outcome Conclusions Subjects with MHI >2.5 have low prevalence of TP-ESE, regardless of PTP. Preliminary MHI assessment may reduce overestimation of PTP of CAD.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Modified Haller index is inversely correlated with true positive exercise stress echocardiographic results

Sonaglioni

Nicolosi²,

Rigamonti

et al. 2022

Journal of Cardiovascular Medicine

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“…A total of 17 studies were thus included in the analysis, totaling 5174 individuals (Table 1). [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] With regard to the RoB, the NIH quality rating was estimated as good for 10 studies and fair for 7 studies (Supplemental Table 1, http://links.lww.com/ JCM/A563).…”

Section: Resultsmentioning

confidence: 99%

“…Our group demonstrated a high prevalence of FP-ESE results among individuals with concave/ flat-shaped chest wall and/or pectus excavatum, as noninvasively defined by a modified Haller index (MHI) of more than 2.5. 20 We hypothesized that the mechanical stress induced by a narrow antero-posterior chest diameter might have a preponderant or at least concurrent role in generating a dynamic LV dyssynchrony, in turn, accentuated by physical exercise and secondary to compressive phenomena within the chest, rather than intrinsic myocardial dysfunction or true ischemia.…”

Section: Resultsmentioning

confidence: 99%

The wide spectrum of determinants of false-positive results on exercise stress echocardiography

Sonaglioni

Lombardo

Nicolosi

et al. 2023

Journal of Cardiovascular Medicine

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“…The clinician should even consider to not require ESE for determining the functional response to MR and for diagnosing obstructive CAD, because of the low probability of MACE over a medium-term follow-up and the excellent prognosis of these participants. [ 39 40 41 ]…”

Section: Discussionmentioning

confidence: 99%

Impact of Chest Wall Conformation on the Outcome of Primary Mitral Regurgitation due to Mitral Valve Prolapse

Sonaglioni

Nicolosi²,

Rigamonti

et al. 2022

Journal of Cardiovascular Echography

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Background: The possible influence of chest wall conformation on cardiovascular (CV) outcome of patients with mitral regurgitation (MR) due to mitral valve prolapse (MVP) has never been previously investigated. Methods: This retrospective study included all consecutive symptomatic patients with MVP and moderate MR who underwent exercise stress echocardiography at our institution between February 2014 and February 2021. Modified Haller Index (MHI; chest transverse diameter over the distance between sternum and spine) was noninvasively assessed. During the follow-up, we evaluated the occurrence of any of the following: (1) CV hospitalization, (2) mitral valve (MV) surgery, and (3) cardiac death or sudden death. Results: Four hundred and twenty-four consecutive patients (66.8 ± 11.5 years, 48.3% men) were retrospectively analyzed. Overall, MVP patients had concave-shaped chest wall (MHI = 2.55 ± 0.34) and were found with small cardiac chamber dimensions. During a mean follow-up time of 3.2 ± 1.7 years, no patients died, 55 patients were hospitalized due to CV events, and 20 patients underwent MV surgery. On multivariate Cox analysis, age (heart rate [HR] 1.05, 95% confidence interval [CI] 1.03–1.06), diabetes mellitus (HR 3.26, 95% CI 2.04–5.20), peak exercise-E/e' ratio (HR 1.07, 95%CI 1.05–1.09), and peak exercise-effective regurgitant orifice area (HR 2.53, 95% CI 1.83–3.51) were directly associated to outcome, whereas MHI (HR 0.15, 95%CI 0.07-0.33) and beta-blocker therapy (HR 0.26, 95% CI 0.19–0.36) showed strong inverse correlation. An MHI ≥2.7 showed 80% sensitivity and 100% specificity for predicting event-free survival (area under the curve = 0.98). Conclusions: Symptomatic patients with moderate MR due to MVP and MHI ≥2.7 have an excellent prognosis over a medium-term follow-up. Noninvasive chest wall shape assessment should be encouraged in clinical practice.

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Does chest shape influence exercise stress echocardiographic results in patients with suspected coronary artery disease?

Cited by 11 publications

References 43 publications

Modified Haller index is inversely correlated with true positive exercise stress echocardiographic results

Modified Haller index is inversely correlated with true positive exercise stress echocardiographic results

The wide spectrum of determinants of false-positive results on exercise stress echocardiography

Impact of Chest Wall Conformation on the Outcome of Primary Mitral Regurgitation due to Mitral Valve Prolapse

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