Modified Haller index is inversely correlated with true positive exercise stress echocardiographic results
Andrea Sonaglioni1, Gian Luigi Nicolosi2, Elisabetta Rigamonti1
1Department of Cardiology, IRCCS, Milan.
Insights
Concave chest wall shape, indicated by a modified Haller index (MHI) greater than 2.5, is associated with a lower likelihood of true positive exercise stress echocardiography (ESE) results for coronary artery disease (CAD). This finding suggests MHI may help refine CAD risk assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Exercise stress echocardiography (ESE) is a key diagnostic tool for suspected coronary artery disease (CAD).
- The impact of chest wall morphology on ESE accuracy remains understudied.
- The modified Haller index (MHI) quantifies chest wall shape, with MHI > 2.5 indicating a concave chest wall.
Purpose of the Study:
- To investigate the relationship between chest wall shape, assessed by MHI, and the predictors of true positive (TP) ESE results in patients with suspected CAD.
- To determine if chest wall conformation influences the diagnostic accuracy of ESE for detecting obstructive CAD.
Main Methods:
- Retrospective analysis of 1275 patients undergoing ESE for suspected CAD.
- Patients categorized by MHI (concave: >2.5 vs. normal: ≤2.5).
- Coronary angiography used to confirm obstructive CAD in patients with positive ESE.
Main Results:
- Patients with concave chests (MHI > 2.5) showed a significantly lower prevalence of TP ESE (2.3%) compared to those with normal chest shapes.
- Pretest probability (PTP) was similar between groups, but MHI > 2.5 was inversely associated with TP ESE (OR 0.25).
- Predictors of TP ESE included PTP, dyslipidemia, and left anterior descending dyssynergy; MHI > 2.5 was a negative predictor.
Conclusions:
- A concave chest wall (MHI > 2.5) is associated with a low prevalence of true positive ESE findings for CAD.
- Preliminary assessment of MHI may help mitigate overestimation of CAD pretest probability.
- Chest wall shape is an important factor to consider in the interpretation of ESE results.
Aims:
The influence of chest wall shape on exercise stress echocardiography (ESE) results has been poorly investigated. We aimed at evaluating the main predictors of true positive (TP)-ESE in a population of subjects with suspected coronary artery disease (CAD), categorized according to chest wall conformation, assessed by modified Haller index (MHI, chest transverse diameter over the distance between sternum and spine).
Methods:
All consecutive patients with suspected CAD referred to our EchoLab for performing ESE between September 2011 and October 2021 were retrospectively enrolled. Preliminary assessment of both pretest probability (PTP) and MHI was performed. All patients with positive ESE underwent coronary angiography. Obstructive CAD was diagnosed by ≥70% stenosis in any epicardial coronary artery. Outcome was TP ESE result.
Results:
One thousand two hundred and seventy-five consecutive patients (64.9 ± 13.0 years) entered the study. Subjects with concave-shaped chest wall (MHI > 2.5) (10.7%) and those with normal chest shape (MHI ≤ 2.5) (89.3%) were separately analyzed. PTP was similar in both groups (21.8 ± 13.2 vs. 23.5 ± 13.3%, P = 0.15). One hundred and seventy patients were diagnosed with positive ESE: 129 (75.9%) had obstructive CAD (TP), whereas the remaining 41 (24.1%) had no CAD. Only 2.3% of TP ESE was detected in subjects with MHI >2.5. PTP [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.04], dyslipidemia (OR 4.37, 95% CI 2.81-6.80), dyssynergy in the left anterior descending territory (OR 8.21, 95% CI 5.07-13.3) were linearly correlated with TP ESE, whereas MHI >2.5 (OR 0.25, 95% CI 0.14-0.67) was inversely associated with outcome.
Conclusions:
Subjects with MHI >2.5 have low prevalence of TP ESE, regardless of PTP. Preliminary MHI assessment may reduce overestimation of PTP of CAD.
Related Concept Videos
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:25Correlation between ECG and Cardiac Cycle
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...