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Complex coronary artery lesion morphology influences results of stress echocardiography
1CNR, Institute of Clinical Physiology, Pisa, Italy.
Insights
Complex coronary lesion morphology, characterized by irregular plaque contours, is linked to higher sensitivity in dipyridamole stress echocardiography (DSE) and more frequent positive responses to low-dose DSE in patients with single-vessel disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Interventional Cardiology
Background:
- Dipyridamole stress echocardiography (DSE) sensitivity correlates with coronary artery disease severity.
- The influence of coronary lesion morphology on DSE outcomes is not well understood.
- Coronary lesion morphology is a known predictor of adverse cardiac events.
Purpose of the Study:
- To investigate the relationship between coronary stenosis lesion morphology and stress echocardiographic results.
- To determine if complex coronary lesions impact DSE sensitivity and response patterns.
Main Methods:
- Analyzed DSE and coronary angiographic data from 68 patients with single-vessel disease.
- Classified lesions as simple or complex based on angiographic features (irregular borders, intraluminal lucencies).
- Compared DSE sensitivity and low-dose DSE positivity between groups with simple and complex lesions.
Main Results:
- DSE sensitivity was significantly lower in patients with simple lesions (53%) compared to complex lesions (85%).
- Low-dose DSE positivity was less frequent in the simple lesion group (17%) versus the complex lesion group (62%).
- Exercise ECG results did not differ significantly between the simple and complex lesion groups.
Conclusions:
- Complex coronary lesion morphology is associated with increased DSE sensitivity.
- Irregular plaque contours, not just geometry, influence stress response in coronary artery disease.
- Complex lesions predict a higher prevalence of positive responses to low-dose DSE.
Background:
The likelihood of a positive response with dipyridamole stress echocardiography (DSE) is directly related to the extent and severity of angiographically assessed coronary artery disease. Whether coronary lesion morphology--a known predictor of adverse cardiac events--may also modulate stress echo results remains unknown. The objective of our study was to assess the relation between stenosis lesion morphology and stress echocardiographic results.
Methods And Results:
High-dose (up to 0.84 mg/kg over 10 minutes) DSE and coronary angiographic data of 68 in-hospital patients (39 with stable angina, 29 with angina at rest) with nonoccluding, single-vessel disease at angiography and no previous myocardial infarction were analyzed. DSE was performed in all patients within 3 days of coronary angiography. An angiographic lesion was considered complex when irregular borders and/or intraluminal lucencies suggestive of ulcer and/or thrombus were present. According to angiographic lesion morphology, two groups were identified: group 1, with simple coronary lesions, and group 2, with complex coronary lesions. The two groups were matched for number of patients (n = 34 in each group), age (group 1, 59 +/- 9 versus group 2, 59 +/- 10 years, P = NS), and coronary artery stenosis severity by quantitative coronary angiography (group 1, 60 +/- 7% versus group 2, 58 +/- 6% diameter reduction, P = NS). The sensitivity of DSE was lower in patients of group 1 when compared with group 2 (53% versus 85%, P < .001). Among positive DSE, the low-dose (0.56 mg/kg over 4 minutes) positivity was less frequent in group 1 than in group 2 patients (17% versus 62%, P < .01). Exercise ECG was completed in 66 patients, and it was positive (> .1 mV ST-segment shift from baseline) in 20 out of 33 group 1 and in 22 out of 33 group 2 patients (61% versus 67%, P = NS). The peak rate-pressure product tended to be higher in group 1 than in group 2 patients (257 +/- 52 versus 240 +/- 64 mm Hg x beats per minute x 10(2), P = NS).
Conclusions:
In patients with single-vessel disease without coronary occlusion or previous myocardial infarction, coronary lesion morphology of the complex type is associated with a higher DSE sensitivity and with a greater prevalence of low-dose, positive responses. Presence of irregular plaque contours, not only plaque geometry, is important in modulating stress responses in the presence of angiographically assessed coronary artery disease.