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Left ventricular transient ischemic dilation during dobutamine stress echocardiography predicts multi-vessel coronary
Nagwa el-Mahalawy1, Zainab Abdel-Salam, Ayman Samir
1Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
Transient ischemic dilation (TID) during dobutamine stress echocardiography is a sensitive and specific predictor of three-vessel coronary artery disease. This non-invasive technique aids in diagnosing significant blockages in multiple coronary arteries.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Echocardiography
Background:
- Coronary artery disease (CAD) diagnosis often relies on invasive angiography.
- Non-invasive methods to predict multi-vessel CAD are valuable for patient management.
- Stress-induced transient ischemic dilation (TID) of the left ventricle is a potential echocardiographic marker.
Purpose of the Study:
- To evaluate the diagnostic value of TID during dobutamine stress echocardiography (DSE) for predicting multi-vessel CAD.
- To establish the sensitivity and specificity of TID in identifying significant coronary artery stenosis.
Main Methods:
- Sixty patients with suspected myocardial ischemia underwent DSE and coronary angiography.
- Left ventricular volumes (end-diastolic and end-systolic) were measured at rest and peak stress to calculate TID ratios (EDV ratio, ESV ratio).
- Patients were categorized into control, ischemic without TID, and ischemic with TID groups.
Main Results:
- TID ratios (EDV and ESV) were significantly higher in patients with ischemic responses compared to controls.
- Receiver operating characteristic (ROC) curve analysis identified an ESV ratio cutoff of 1.12 for predicting three-vessel disease with 90% sensitivity and 84% specificity.
- Patients with TID had a higher mean number of affected coronary vessels.
Conclusions:
- Transient ischemic dilation (TID) during DSE is a sensitive and specific indicator of three-vessel coronary artery disease.
- TID can reliably predict the presence and extent of significant coronary artery stenosis.
- This echocardiographic finding aids in non-invasively assessing the severity of CAD.
Background:
We sought to explore the value of stress-induced transient ischemic dilation (TID) of the left ventricle during dobutamine stress echocardiography, to predict the presence of multi-vessel coronary artery disease as seen by coronary angiography.
Methods:
We enrolled 60 patients referred to our stress echocardiography labs with ischemic-type chest pain or other symptoms suggestive of myocardial ischemia. All patients underwent resting and stress echocardiography employing the standard dobutamine stress protocol. TID ratio was defined as the ratio of left ventricular end-diastolic volume or end-systolic volume measured at peak stress, to that measured at rest (EDV ratio and ESV ratio, respectively). We enrolled 20 consecutive patients with normal response (control group) who were subsequently evaluated to develop normal limits for TID ratio, and 40 patients with ischemic response (study group) that comprised 20 consecutive patients without TID (group A) and 20 consecutive patients with TID (group B). Patients then underwent coronary angiography.
Results:
Both EDV ratio and ESV ratio were significantly higher in groups A and B as compared to the control group (P<0.01 for both). Analysis of the receiver operating characteristic (ROC) curves identified the 1.12 cutoff value as the optimal cutoff value of TID ratio that best predicts three-vessel disease. Using this cutoff value, the ESV ratio was able to predict three-vessel disease with a sensitivity of 90%, specificity 84%, positive and negative predictive values of 85% and 89%, respectively. The mean number of vessels affected by significant stenosis was 1.8+/-0.83 in group A in comparison with 2.45+/-0.69 in group B (P<0.05). Among group B, both EDV ratio and ESV ratio were higher in female patients as compared to male ones.
Conclusions:
In patients undergoing dobutamine stress echocardiography, the occurrence of TID is both sensitive and specific to predict underlying three-vessel coronary artery disease.
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