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accuracy of exercise echocardiography for detecting significant epicardial coronary artery stenosis

Session Poster session 1

Speaker Ines Silveira

Event : EuroEcho 2017

  • Topic : imaging
  • Sub-topic : Stress Echocardiography
  • Session type : Poster Session

Authors : I Silveira (Porto,PT), M Trepa (Porto,PT), R B Santos (Porto,PT), B Brochado (Porto,PT), M Santos (Porto,PT), N Antunes (Porto,PT), V Alves-Dias (Porto,PT), F Oliveira (Porto,PT), L Sousa-Pereira (Porto,PT), A Luz (Porto,PT), S Cabral (Porto,PT), S Torres (Porto,PT)

Authors:
I Silveira1 , M Trepa1 , R B Santos1 , B Brochado1 , M Santos1 , N Antunes1 , V Alves-Dias1 , F Oliveira1 , L Sousa-Pereira1 , A Luz1 , S Cabral1 , S Torres1 , 1Hospital Center of Porto, Cardiology - Porto - Portugal ,

Citation:
European Heart Journal Supplements ( 2017 ) 18 ( Supplement 3 ), iii67

Introduction: Exercise echocardiography (execho) is an extensively used imaging stress tool to assess patients with suspected coronary artery disease. We aimed to determine the diagnostic accuracy of execho for detecting significant epicardial coronary artery stenosis (EpCS). 

Methods: Single-center, observational, retrospective study of patients referred for treadmill execho who subsequently underwent invasive coronary angiography. Significant EpCS was defined as the presence of a coronary artery stenosis > 50%. Predictors of a positive execho without significant EpCS were determined by logistic regression analysis. Variables with p<0.1 in univariate analysis were included in multivariate model. 

Results: We studied 142 patients, 76.2% were male, overall mean age of 64 ± 9 years. Regarding cardiovascular risk factors: 79.7% of patients had dyslipidemia, 72.2% hypertension, 39.5%, smoke exposure and 31.5% diabetes. A history of coronary artery disease (CAD) was reported in 54.6%. A positive execho (n=104) without significant EpCS was observed in 35 patients: these patients were more frequently women (40.0% vs 14.5% p=0.003), had less prevalence of dyslipidemia (65.7% vs 87.0% p=0.010), smoke exposure (20.0% vs 46.4% p=0.016) and less history of CAD (17.1% vs 72.5% p<0.001) compared to true positive execho. They also had a lower wall motion score index (WMSI) at baseline (1.2 ± 0.3 vs 1.4 ± 0.4 p=0.006) and a reduced WMSI variation after exercise test (? WMSI 0.34 ± 0.26 vs 0.51 ± 0.34 p=0.014). There was no significant differences on functional capacity (8.2 ± 1.9 vs 7.8 ± 2.2 METs p=0.35). Overall, execho sensitivity was 87.3% and specificity 48.3%. In patients with history of CAD, there was a higher specificity 72.2% with a similar sensitivity rate (86.4%).  Patients without known CAD had worse specificity 37.5% but higher sensitivity 92%. Only female gender (OR: 5.86; 95% CI 1.60-21.51; p=0.008), WMSI variation (OR: 0.09; 95% CI 0.01-0.66; p=0.018) and absence of history of CAD (OR: 0.07; 95% CI 0.02-0.24; p<0.001) were independent predictors of positive execho without significant EpCS. 

Conclusion: In concordance to previous studies, our data show execho as a useful tool to exclude significant EpCS. This method had a high sensitivity but a suboptimal specificity, especially in patients without known coronary disease. Female gender, reduced WMSI variation and absence of previous CAD were significantly associated to the false positive execho.

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