Detection of high-burden coronary artery disease by exercise-induced changes of the E/E' ratio

Area of Science:

• Cardiology
• Echocardiography
• Diagnostic Imaging

Background:

• Coronary artery disease (CAD) diagnosis often relies on invasive procedures.
• Non-invasive methods are crucial for assessing CAD burden, especially in patients with chest pain and preserved left ventricular (LV) systolic function.

Purpose of the Study:

• To evaluate the efficacy of exercise-induced changes in the average E/E' ratio for detecting high-burden coronary artery disease (CAD).
• To compare the diagnostic performance of exercise-induced E/E' ratio changes against myocardial scintigraphy and exercise-induced wall motion abnormalities.

Main Methods:

• 359 patients with chest pain and normal LV systolic function underwent exercise echocardiography, scintigraphy, and coronary angiography.
• Calculated the average E/E' ratio (early diastolic transmitral velocity to early diastolic tissue velocity) at rest and post-exercise.
• Assessed exercise-induced wall motion abnormalities and compared diagnostic values.

Main Results:

• Exercise-induced E/E' ratio changes demonstrated 87.3% sensitivity and 75.2% specificity for detecting flow-limiting CAD.
• This method showed higher diagnostic value compared to myocardial scintigraphy (79.2% sensitivity, 80.1% specificity) and wall motion abnormalities (74.3% sensitivity, 66.9% specificity).
• Likelihood ratio chi-square analysis confirmed the incremental value of exercise-induced E/E' ratio changes over other techniques.

Conclusions:

• Exercise-induced changes in the average E/E' ratio are effective in detecting high-burden CAD in patients with chest pain and normal LV systolic function.
• This echocardiographic parameter offers an incremental diagnostic advantage over traditional methods like scintigraphy and wall motion analysis.