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Association of Coronary Computed Tomography Angiography and Stress Echocardiography with Long-Term Cardiac Outcome: A
Nicola Gaibazzi1, Fausto Rigo2, Valentina Lorenzoni3
1Department of Cardiology, Parma University Hospital, 43126 Parma, Italy.
Insights
Coronary artery calcium score from CT angiography and coronary flow velocity reserve from stress echocardiography are key predictors of long-term cardiac events in suspected chronic coronary syndrome patients.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Non-invasive Cardiac Testing
Background:
- Chronic coronary syndrome (CCS) diagnosis relies on integrating clinical assessment with non-invasive testing.
- Coronary computed tomography angiography (CTA) and vasodilator stress-echocardiography (SE) are frequently used modalities.
- Identifying predictors of long-term cardiac outcomes from these tests is crucial for risk stratification.
Purpose of the Study:
- To determine which variables from CTA and SE best predict long-term cardiac outcomes in patients with suspected CCS.
- To compare the prognostic value of specific imaging markers from both modalities.
Main Methods:
- Retrospective analysis of 397 patients with suspected CCS who underwent both SE and CTA within 30 days.
- CTA assessed coronary artery calcium score (CACS) and number of >50% stenosed vessels.
- SE assessed reversible regional wall motion abnormalities (RWMA) and coronary flow velocity reserve (CFVR) in the left anterior descending artery.
- Fine and Gray competing risk models evaluated associations with cardiac death or myocardial infarction.
Main Results:
- During a median 10-year follow-up, 57 cardiac events occurred.
- Both RWMA, lower CFVR, CACS, and number of stenosed vessels were initially associated with cardiac events.
- After multivariable adjustment, only CACS (CTA) and CFVR (SE) remained independently associated with long-term cardiac outcome.
Conclusions:
- Coronary artery calcium score (CACS) on CTA and coronary flow velocity reserve (CFVR) on SE are the strongest independent predictors of long-term cardiac events in suspected CCS.
- Traditional markers like RWMA and number of stenosed vessels may be less prognostically significant than CACS and CFVR.
Aims:
This study aimed to assess which variables on coronary computed tomography angiography (CTA) and vasodilator stress-echocardiography (SE) are best associated with long-term cardiac outcome in patients presenting for suspected chronic coronary syndrome (CCS) who performed both tests.
Methods:
We identified 397 patients with suspected CCS who, between 2007 and 2019, underwent both SE and CTA within 30 days. Coronary artery calcium score (CACS) and the number of coronary arteries with diameter stenosis >50% were assessed on CTA. The presence of reversible regional wall motion abnormalities (RWMA) and reduced Doppler coronary flow velocity reserve in the left-anterior descending coronary artery (CFVR) were assessed on SE. The association of SE and CTA variables with cardiac outcome (cardiac death or myocardial infarction) was evaluated using Fine and Gray competing risk models.
Results:
During a median follow-up of 10 years, 38 (9.6%) patients experienced a nonfatal myocardial infarction and 19 (4.8%) died from a cardiac cause. RWMA (HR 7.189, p < 0.001) and a lower CFVR (HR 0.034, p < 0.001) on SE, along with CACS (HR 1.004, p < 0.001) and the number of >50% stenosed coronary vessels (HR 1.975, p < 0.001) on CTA, were each associated with cardiac events. After adjusting for covariates, only CACS and CFVR remained associated (both p < 0.001) with cardiac outcome.
Conclusion:
Our data suggest that only CFVR on vasodilatory SE and CACS on CTA are independently and strongly associated with long-term cardiac outcome, unlike RWMA or the number of stenosed coronary arteries, usually considered the hallmarks of coronary artery disease on each test.
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