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Published on: April 13, 2015
A novel echocardiographic method for the prediction of coronary artery disease
Yilmaz Güneş1, Mustafa Tuncer, Mustafa Yildirim
1Yuzuncu Yil University, Faculty of Medicine, Cardiology Department, Van, Turkey.
Insights
Echocardiographic determination of aortic velocity of propagation (AVP) can rapidly predict coronary artery disease (CAD). A low AVP value (< or =41 cm/s) indicates a high likelihood of CAD, aiding early risk stratification.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Ultrasound
- Clinical Cardiology
Background:
- Coronary artery disease (CAD) is a leading cause of mortality, necessitating effective prevention and early detection strategies.
- While ultrasound offers valid cardiovascular assessment, a rapid method for CAD prediction is lacking.
- Current diagnostic approaches for CAD require timely and efficient risk stratification tools.
Purpose of the Study:
- To evaluate the utility of echocardiographic parameters in predicting significant coronary artery disease (CAD).
- To determine if aortic strain, distensibility, pulse-wave propagation velocity (PWPV), and color M-mode propagation velocity of the descending aorta (AVP) can predict CAD.
- To establish AVP as a rapid bedside tool for CAD risk stratification.
Main Methods:
- Ninety-one patients with significant CAD and 36 controls with normal coronary arteries were studied.
- Measurements included aortic strain, aortic distensibility, PWPV, and color M-mode AVP.
- Multivariate regression analysis and receiver operating curve (ROC) analysis were performed.
Main Results:
- Patients with CAD had significantly lower left ventricular ejection fraction and AVP, and higher PWPV compared to controls.
- Multivariate analysis identified AVP (beta=0.850, p<0.001) and PWPV (beta=0.008) as significant CAD predictors.
- An AVP cutoff of <=41 cm/s demonstrated 82.4% sensitivity and 97.2% specificity for CAD detection.
Conclusions:
- Bedside risk stratification for CAD is feasible using echocardiographic AVP measurement.
- AVP is a novel and highly specific parameter for identifying patients with CAD.
- This method can guide further diagnostic strategies for patients at risk of CAD.
Background:
Coronary artery disease (CAD) is a leading cause of death and prevention and early detection of CAD are major goals of healthcare. Although ultrasound methods allow valid and repeatable detection of structure and function of cardiovascular system, a rapid ultrasonographic method for the prediction of CAD has not yet been defined.
Material/Methods:
Ninety-one patients with newly diagnosed significant CAD on coronary angiography and 36 patients with normal coronary arteries were included in the study. Aortic strain, aortic distensibility, aortofemoral pulse-wave propagation velocity (PWPV), and color M-mode propagation velocity of the descending aorta (AVP) were measured.
Results:
Male sex and smoking were significantly more frequent in the CAD group. Mean values of the left ventricular ejection fraction and AVP were significantly lower with higher PWPV in patients with CAD than controls. Multivariate regression analysis including age, hypertension, LDL cholesterol, diabetes, smoking habit, body mass index, left ventricular ejection fraction, AVP, aortic strain, aortic distensibility, and PWPV revealed that AVP (beta=0.850, p<0.001) and PWPV (beta=0.166, p=0.008) were the only significant predictors of CAD. However, when AVP was extracted from the regression model, the adjusted R2 decreased from 0.652 to 0.099. An AVP value of < or =41 cm/s, determined by receiver operating curve analysis, predicted CAD with 82.4% sensitivity and 97.2% specificity (positive predictive value: 98.7% and negative predictive value: 68.2%).
Conclusions:
Bedside risk stratification for CAD is feasible by echocardiographic determination of AVP. This novel parameter may be particularly useful in identifying patients who will benefit from further diagnostic strategies for CAD.
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