Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis
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 consec...
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MDPI AG
2022-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/20/6185 |
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| author | Ibadete Bytyçi Liliana Alves Oscar Alves Carla Lopes Gani Bajraktari Michael Y. Henein |
| author_facet | Ibadete Bytyçi Liliana Alves Oscar Alves Carla Lopes Gani Bajraktari Michael Y. Henein |
| author_sort | Ibadete Bytyçi |
| collection | DOAJ |
| description | 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 (<i>n</i> = 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 (<i>p</i> > 0.05). The WMSI was higher and t-IVT more prolonged in patients with CAD (<i>p</i> < 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; <i>p</i> < 0.001), Δ E velocity OR 2.502 (1.179 to 1.108; <i>p</i> < 0.001), Δ t-IVT 2.206 (1.180 to 2.780; <i>p</i> < 0.001) and Δ WMSI OR 1.911 (1.401 to 3.001; <i>p</i> = 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%; <i>p</i> = 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. |
| first_indexed | 2024-03-09T03:35:14Z |
| format | Article |
| id | doaj.art-1c04b293982643fbbbfdba8591a3f8d9 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T03:35:14Z |
| publishDate | 2022-10-01 |
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| spelling | doaj.art-1c04b293982643fbbbfdba8591a3f8d92023-12-03T14:48:58ZengMDPI AGJournal of Clinical Medicine2077-03832022-10-011120618510.3390/jcm11206185Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery StenosisIbadete Bytyçi0Liliana Alves1Oscar Alves2Carla Lopes3Gani Bajraktari4Michael Y. Henein5Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, KosovoDepartment of Cardiology, The Bedfordshire Hospitals NHS Trust, Luton LU4 0DZ, UKDepartment of Cardiology, The Bedfordshire Hospitals NHS Trust, Luton LU4 0DZ, UKDepartment of Cardiology, The Bedfordshire Hospitals NHS Trust, Luton LU4 0DZ, UKClinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, KosovoInstitute of Public Health and Clinical Medicine, Umeå University, 90187 Umea, SwedenBackground 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 (<i>n</i> = 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 (<i>p</i> > 0.05). The WMSI was higher and t-IVT more prolonged in patients with CAD (<i>p</i> < 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; <i>p</i> < 0.001), Δ E velocity OR 2.502 (1.179 to 1.108; <i>p</i> < 0.001), Δ t-IVT 2.206 (1.180 to 2.780; <i>p</i> < 0.001) and Δ WMSI OR 1.911 (1.401 to 3.001; <i>p</i> = 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%; <i>p</i> = 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.https://www.mdpi.com/2077-0383/11/20/6185suspected coronary artery diseaseinsignificant coronary artery diseasedobutamine stress echocardiography |
| spellingShingle | Ibadete Bytyçi Liliana Alves Oscar Alves Carla Lopes Gani Bajraktari Michael Y. Henein Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis Journal of Clinical Medicine suspected coronary artery disease insignificant coronary artery disease dobutamine stress echocardiography |
| title | Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis |
| title_full | Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis |
| title_fullStr | Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis |
| title_full_unstemmed | Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis |
| title_short | Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis |
| title_sort | left ventricular myocardial and cavity velocity disturbances are powerful predictors of significant coronary artery stenosis |
| topic | suspected coronary artery disease insignificant coronary artery disease dobutamine stress echocardiography |
| url | https://www.mdpi.com/2077-0383/11/20/6185 |
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