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Published on: September 22, 2023
Resting echocardiographic parameters can exclude significant coronary artery disease: A comparison with coronary
Shinji Jinno1, Akira Yamada2, Kunihiko Sugimoto1
1Clinical Laboratory, Fujita Health University Hospital, Toyoake, Aichi, Japan.
Insights
Resting echocardiography parameters, specifically left atrial volume index (LAVI) and left ventricular global longitudinal strain (GLS), can help exclude significant coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA). Combining these measurements offers a high negative predictive value for ruling out CAD.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Coronary computed tomography angiography (CCTA) is a valuable tool for diagnosing coronary artery disease (CAD).
- High negative predictive value (NPV) of CCTA is crucial for ruling out significant CAD.
Purpose of the Study:
- To evaluate if resting echocardiographic parameters can effectively exclude significant CAD detected by CCTA.
- Identify specific echocardiographic predictors for non-significant CAD.
Main Methods:
- 142 patients with both CCTA and echocardiography within 3 months were analyzed.
- Patients were grouped based on CCTA findings: non-significant CAD (<50% stenosis) and significant CAD.
- Resting echocardiographic parameters were compared between groups.
Main Results:
- 92 patients were eligible; 50 in the non-significant CAD group and 42 in the significant CAD group.
- Lower left atrial volume index (LAVI) and left ventricular global longitudinal strain (GLS) were observed in the non-significant CAD group.
- Combined LAVI (<29.0 mL/m²) and GLS (< -18.1%) achieved a 95.0% NPV for excluding significant CAD.
Conclusions:
- Resting LAVI and GLS are clinically useful in excluding significant CAD when assessed by CCTA.
- The combined use of LAVI and GLS enhances the ability to rule out significant CAD non-invasively.
Introduction:
Coronary computed tomography angiography (CCTA) is known to have a high negative predictive value (NPV) in identifying coronary artery disease (CAD). This study aimed to examine whether resting echocardiographic parameters could exclude significant CAD on CCTA.
Methods:
We recruited 142 patients who had undergone both CCTA and echocardiography within a 3-month window. Based on the CCTA findings, patients were divided into two groups: Group A (non-significant CAD, defined as all coronary segments having <50% stenosis) and Group B (significant CAD). Resting echocardiographic parameters were compared between the two groups to identify predictors of non-significant CAD on CCTA.
Results:
A total 92 patients (mean age, 68 ± 13 years; males, 62%) were eligible for this study; 50 in Group A and 42 in Group B. Among the various echo parameters, left atrial volume index (LAVI) and left ventricular (LV) global longitudinal strain (GLS) were significantly lower in Group A (23.5 ± 7.6 vs. 33.6 ± 7.4 mL/m2 , p < .001; -20.2 ± 1.8% vs. -16.8 ± 2.0%, p < .001, respectively). Analysis of the receiver operating characteristic curve revealed that the cutoff value to exclude significant CAD on CCTA was 29.0 mL/m2 for LAVI (NPV 80.8%) and -18.1% for GLS (NPV 80.7%). The NPV increased to 95.0% when these parameters were combined (LAVI < 29.0 mL/m2 and GLS < -18.1%).
Conclusion:
The combination of resting LAVI and GLS was clinically useful in excluding significant CAD via CCTA.
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