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Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery
Published on: February 20, 2017
Is It Possible to Predict False-Positive Exercise Stress Echocardiography Results by Measuring the Left Atrial
Andrea Sonaglioni1, Gian Luigi Nicolosi2, Michele Lombardo1
1Cardiology, MultiMedica Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, ITA.
Insights
Left atrial antero-posterior diameter adjusted for chest wall dimensions can help identify patients with a low probability of coronary artery disease (CAD). This screening method shows high sensitivity and specificity for predicting false-positive exercise stress echocardiography results.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Echocardiography
Background:
- Left atrial (LA) size is a known prognostic factor in coronary artery disease (CAD).
- Previous studies have not evaluated LA antero-posterior (A-P) diameter for screening low-probability CAD patients.
- This study investigates LA A-P diameter adjusted for thoracic dimensions to predict false-positive (FP) exercise stress echocardiography (ESE) results.
Purpose of the Study:
- To assess the influence of LA A-P diameter adjusted for A-P thoracic diameter on FP-ESE occurrence.
- To determine if this ratio can serve as a screening tool for identifying individuals with a low probability of obstructive CAD.
Main Methods:
- Retrospective analysis of 160 patients with suspected CAD and positive ESE undergoing coronary angiography.
- Assessment of LA A-P diameter/A-P thoracic diameter ratio and resting transthoracic echocardiography.
- Primary endpoint: FP-ESE, defined as positive ESE without obstructive CAD (≥70% stenosis).
Main Results:
- 19.4% of patients (31/160) had FP-ESE.
- LA A-P diameter/A-P thoracic diameter ratio showed a strong inverse correlation with FP-ESE (OR 0.42).
- A ratio ≤0.25 demonstrated 100% sensitivity and 85% specificity for predicting FP-ESE (AUC=0.94).
Conclusions:
- Echocardiographic LA A-P diameter adjusted for thoracic diameter is a valuable tool.
- This measurement can help identify patients at lower risk of obstructive CAD among those with suspected CAD.
- It aids in predicting false-positive ESE results, potentially reducing unnecessary invasive procedures.
Background:
Left atrial (LA) size is a well-known prognostic determinant in the setting of coronary artery disease (CAD). No previous study has evaluated LA antero-posterior (A-P) diameter as a potential screening method for identifying individuals with a low probability of CAD. We aimed to assess the influence of LA A-P diameter adjusted for chest wall conformation (A-P thoracic diameter) on the occurrence of false-positive (FP) results on exercise stress echocardiography (ESE) in patients with suspected CAD.
Methods:
All consecutive patients who had undergone coronary angiography at MultiMedica IRCCS (via San vittore 12, 20123, Milan, Italy) within two months from a positive ESE over a seven-year period were retrospectively analyzed. All patients underwent LA A-P diameter/A-P thoracic diameter ratio assessment, resting transthoracic echocardiography, and subsequent ESE. The primary endpoint was FP-ESE, defined as a positive ESE with no evidence of obstructive CAD (≥70% stenosis in any epicardial coronary artery) on subsequent coronary angiography.
Results:
A total of 160 patients (64.4±13.0 years, 56.9% females) with a positive ESE were retrospectively analyzed. In light of coronary angiography results, 129 patients (80.6%) had an obstructive CAD, while 31 (19.4%) did not (FP). On the multivariate logistic regression analysis, the LA A-P diameter/A-P thoracic diameter ratio (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.31-0.57) showed a strong inverse correlation with the primary endpoint. An LA A-P diameter/A-P thoracic diameter ratio ≤0.25 had 100% sensitivity and 85% specificity for predicting FP-ESE results (area under the curve (AUC) = 0.94). A strong linear correlation was demonstrated between the LA A-P diameter and A-P thoracic diameter (r = 0.85), whereas the correlation between the LA volume index and A-P thoracic diameter was moderate (r = 0.47).
Conclusions:
Echocardiographic assessment of the LA A-P diameter adjusted for the A-P thoracic diameter may allow clinicians to identify, among individuals with suspected CAD, those at lower risk of obstructive CAD.
