Non-invasive diagnosis of coronary artery disease by quantitative stress echocardiography: optimal diagnostic models
C F Mädler1, N Payne, U Wilkenshoff
1University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, Wales, UK.
Insights
Objective non-invasive diagnosis of coronary artery disease using dobutamine stress echocardiography is optimized with logistic regression models. These models analyze myocardial Doppler velocities, adjusting for heart rate, age, and gender for improved accuracy.
Area of Science:
- Cardiology
- Echocardiography
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) diagnosis often requires invasive procedures.
- Non-invasive methods are crucial for early and accurate CAD detection.
- Dobutamine stress echocardiography (DSE) assesses myocardial function under stress.
Purpose of the Study:
- To develop and optimize objective, non-invasive diagnostic methods for CAD.
- To utilize myocardial Doppler velocities during DSE for improved diagnostic accuracy.
- To establish quantitative criteria for CAD detection using stress echocardiography.
Main Methods:
- Acquired tissue Doppler data during DSE in 289 subjects.
- Analyzed myocardial velocities in 11 left ventricular segments.
- Developed logistic regression models using systolic velocities, heart rate, age, and gender.
Main Results:
- Logistic regression models achieved optimal diagnostic accuracy for CAD.
- Models using 7 myocardial segments demonstrated high sensitivity and specificity.
- Diagnostic performance for LAD, Cx, and RCA disease ranged from 80-93% sensitivity and 80-82% specificity.
- Models outperformed simple velocity cut-offs (p<0.001).
Conclusions:
- Quantitative stress echocardiography with diagnostic models offers effective non-invasive CAD diagnosis.
- Models incorporating segmental velocities at peak stress are superior.
- Adjusting for heart rate, age, and gender further enhances diagnostic precision.
Aims:
To develop optimal methods for the objective non-invasive diagnosis of coronary artery disease, using myocardial Doppler velocities during dobutamine stress echocardiography.
Methods And Results:
We acquired tissue Doppler digital data during dobutamine stress in 289 subjects, and measured myocardial responses by off-line analysis of 11 left ventricular segments. Diagnostic criteria developed by comparing 92 normal subjects with 48 patients with coronary disease were refined in a prospective series of 149 patients referred with chest pain. Optimal diagnostic accuracy was achieved by logistic regression models, using systolic velocities at maximal stress in 7 myocardial segments, adjusting for independent correlations directly with heart rate and inversely with age and female gender (all p<0.001). Best cut-points from receiver-operator curves diagnosed left anterior descending, circumflex and right coronary disease with sensitivities and specificities of 80% and 80%, 91% and 80%, and 93% and 82%, respectively. All models performed better than velocity cut-offs alone (p<0.001).
Conclusion:
Non-invasive diagnosis of coronary artery disease by quantitative stress echocardiography is best performed using diagnostic models based on segmental velocities at peak stress and adjusting for heart rate, and gender or age.
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