Predicting clinically unrecognized coronary artery disease: use of two- dimensional echocardiography

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Tools

Background:

• 2-D Echo is frequently used in patients without a history of coronary artery disease (CAD).
• Identifying echo features predictive of CAD is crucial for risk stratification.

Purpose of the Study:

• To determine specific 2-D Echo features that can predict the presence of CAD in patients without prior diagnosis.
• To assess the incremental value of 2-D Echo findings over clinical information in predicting CAD.

Main Methods:

• Review of 2-D Echo from 328 patients without known CAD, performed before stress myocardial SPECT and angiography.
• Examination of echo features including ventricular/atrial enlargement, hypertrophy, wall motion abnormality (WMA), low ejection fraction (EF), mitral annular calcification (MAC), and aortic sclerosis/stenosis (AS).
• Definition of high-risk myocardial perfusion abnormality (MPA) and severe coronary artery stenosis (CAS) based on established criteria.

Main Results:

• Multivariate analysis identified age >65, male sex, inability to exercise, diabetes mellitus (DM), WMA, MAC, and AS as independent predictors of MPA and CAS.
• Age, DM, inability to exercise, and WMA were independent predictors of high-risk MPA and severe CAS.
• 2-D Echo findings provided incremental value over clinical information in predicting CAD (Chi square: 360 vs. 320, p = 0.02).

Conclusions:

• 2-D Echo is a valuable tool for predicting both physiological and anatomical CAD.
• Echocardiographic findings, particularly WMA, significantly enhance the prediction of CAD beyond clinical risk factors.