Health & Medical Cardiovascular Health

Predicting Clinically Unrecognized CAD: Use of 2D Echocardiography

´╗┐Predicting Clinically Unrecognized CAD: Use of 2D Echocardiography

Abstract and Background

Abstract


Background: 2-D Echo is often performed in patients without history of coronary artery disease (CAD). We sought to determine echo features predictive of CAD.
Methods: 2-D Echo of 328 patients without known CAD performed within one year prior to stress myocardial SPECT and angiography were reviewed. Echo features examined were left ventricular and atrial enlargement, LV hypertrophy, wall motion abnormality (WMA), LV ejection fraction (EF) < 50%, mitral annular calcification (MAC) and aortic sclerosis/stenosis (AS). High risk myocardial perfusion abnormality (MPA) was defined as > 15% LV perfusion defect or multivessel distribution. Severe coronary artery stenosis (CAS) was defined as left main, 3 VD or 2VD involving proximal LAD.
Results: The mean age was 62 ┬▒ 13 years, 59% men, 29% diabetic (DM) and 148 (45%) had > 2 risk factors. Pharmacologic stress was performed in 109 patients (33%). MPA was present in 200 pts (60%) of which, 137 were high risk. CAS was present in 166 pts (51%), 75 were severe. Of 87 patients with WMA, 83% had MPA and 78% had CAS. Multivariate analysis identified age > 65, male, inability to exercise, DM, WMA, MAC and AS as independent predictors of MPA and CAS. Independent predictors of high risk MPA and severe CAS were age, DM, inability to exercise and WMA.
2-D echo findings offered incremental value over clinical information in predicting CAD by angiography. (Chi square: 360 vs. 320 p = 0.02).
Conclusion: 2-D Echo was valuable in predicting presence of physiological and anatomical CAD in addition to clinical information.

Background


Two-Dimensional echocardiography (2-D Echo) is well accepted for evaluation of cardiac function. It is the most employed cardiovascular imaging modality for assessment of cardiovascular disease and is often performed in patients without history of coronary artery disease (CAD). It is well established that several echocardiograpahic measurements provide powerful prognostic information for cardiovascular outcomes such as presence of left ventricular hypertrophy, aortic sclerosis and LVEF. However, the association of these features with underlying CAD is less well established.

Although association of CAD and some isolated echo findings have been examined, no study have performed a direct comparison of different echo feature in predicting CAD in patients without history of CAD. Therefore, we sought to compare different echo findings to determine independent 2-D echo predictors of underlying anatomical CAD by angiographic coronary artery stenosis (CAS) and also physiological CAD by myocardial perfusion abnormality (MPA) by SPECT. Stress myocardial SEPCT imaging is the most commonly used imaging technique in assessment of suspected CAD. It provides high diagnostic accuracy for detection of angiographic CAD and adds incremental prognostic value over angiographic information.

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