Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis

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.

Strain Rate Changes during Stress Echocardiography Are the Most Accurate Predictors of Significant Coronary Artery Disease in Patients with Previously Treated Acute Coronary Syndrome

“…Secondly, the myocardial SR represents the velocity of deformation and shortening of the longitudinal segments with respect to the original segmental length. This finding supports our previously reported findings before and during coronary angioplasty, where myocardial segmental velocities proved the most sensitive in reflecting acute ischemia [31,32] as well as successful revascularization [30,33]. Thirdly, it seems that the accuracy of SR changes in predicting culprit lesions is higher for the left coronary system compared to the right, in particular the LAD subtended segments.…”

“…The reason behind such a difference in accuracy is three-fold. Firstly, myocardial deformation reflects the intrinsic longitudinal function, which itself reflects the function of the sub-endocardium, the most sensitive myocardial layer to ischemia [29,30]. This is in contrast to a wall motion analysis, which reflects the transvers full thickness myocardial circumferential function.…”

The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology

“…Coronary artery calcification and segment involvement scores were associated with a five-year coronary event incidence, independent of cardiovascular risk factors [ 2 ]. In the research field, left ventricular myocardial and cavity Doppler velocity disturbances have been suggested to have the potential to become powerful predictors of significant coronary artery stenosis, as assessed using dobutamine stress Doppler echocardiography [ 3 ].…”

Short-Term Outcomes of Total Arterial Revascularization Compared to Conventional Coronary Artery Bypass Graft in Patients with Multivessel Disease and Left Ventricular Dysfunction

“…However, not all patients who undergo CABG have the same prognosis. A major factor that infuences the outcomes of CABG is the presence of left ventricular dysfunction (LVD) [4]. LVD is a common complication of multivessel CAD, which impairs the cardiac output and increases the risk of adverse cardiac events [5].…”