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Sonaglioni A, Nicolosi GL, Rigamonti E, Lombardo M, Gensini GF, Ambrosio G. Does chest shape influence exercise stress echocardiographic results in patients with suspected coronary artery disease? Intern Emerg Med 2022; 17:101-112. [PMID: 34052977 DOI: 10.1007/s11739-021-02773-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/22/2021] [Indexed: 10/20/2022]
Abstract
Despite the good specificity of exercise stress echocardiography (ESE) for the detection of coronary artery disease (CAD), false positive (FP) results may occur. We have previously reported that chest abnormalities may affect parameters of cardiac contractility. The influence of chest shape on ESE results has never been previously investigated. We retrospectively analyzed 160 consecutive patients (64.4 ± 13.0-year old, 91 women) who had undergone coronary angiography at our Institution because of positive ESE, between June 2014 and May 2020. Modified Haller index (MHI; chest transverse diameter over the distance between sternum and spine) was assessed in all patients. Obstructive CAD was diagnosed by ≥ 70% stenosis in any epicardial coronary artery. Outcome was false-positivity at ESE. 80.6% of patients were diagnosed with obstructive CAD, while 19.4% had no CAD (FP). We separately analyzed patients with normal chest shape (MHI ≤ 2.5) and those with concave-shaped chest wall (MHI > 2.5). These latter were mostly women with small cardiac chambers, mitral valve prolapse (MVP) and exercise-induced ST-segment changes. Likelihood of false-positivity was significantly higher in subjects with MHI > 2.5 than those with MHI ≤ 2.5 (30.7% vs 9.4%, p = 0.001). By multivariate logistic regression analysis, MHI > 2.5 (OR 4.04, 95%CI 1.45-11.2, p = 0.007), MVP (OR 3.47, 95%CI 1.32-9-12, p = 0.01) and dyssynergy in the left circumflex territory (OR = 3.35, 95%CI 1.26-8.93, p = 0.01) were independently associated with false-positivity. Concave-shaped chest wall (MHI > 2.5) may be associated with false-positive stress echocardiographic result. Mechanisms underpinning this finding need to be further explored.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy.
| | | | - Elisabetta Rigamonti
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| | - Gian Franco Gensini
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
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Sonaglioni A, Rigamonti E, Nicolosi GL, Lombardo M. Prognostic Value of Modified Haller Index in Patients with Suspected Coronary Artery Disease Referred for Exercise Stress Echocardiography. J Cardiovasc Echogr 2021; 31:85-95. [PMID: 34485034 PMCID: PMC8388326 DOI: 10.4103/jcecho.jcecho_141_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/17/2021] [Indexed: 01/28/2023] Open
Abstract
Background: The influence of chest conformation on outcome of patients with suspected coronary artery disease (CAD) is actually unknown. Materials and Methods: This retrospective study included all consecutive patients who underwent exercise stress echocardiography (ESE) for suspected CAD at our institution between February 2011 and September 2019. Modified Haller index (MHI; chest transverse diameter over the distance between sternum and spine) was assessed in all patients. Obstructive CAD was diagnosed by ≥70% stenosis in any epicardial coronary artery. During the follow-up time, we evaluated the occurrence of any of the following: (1) cardiovascular (CV) hospitalizations and (2) cardiac death or sudden death. Results: A total of 1091 consecutive patients (62.4 ± 12.6 years, 57.2% of men) were included in the study. Patients with normal chest shape (MHI ≤2.5) and those with concave-shaped chest wall (MHI >2.5) were separately analyzed. A positive ESE was diagnosed in 171 patients of which 80.7% had an obstructive CAD (true positive), while 19.3 not (false positive [FP]). Majority of FP ESE (70.9%) derived from concave-shaped chest wall group. During follow-up time (2.5 ± 1.9 years), 9 patients died and 281 were hospitalized because of heart failure (163), acute coronary syndromes (39), and arrhythmias (79). At the multivariate Cox regression analysis, age (heart rate [HR]: 1.02, 95% confidence interval [CI]: 1.01–1.03), MHI >2.5 (HR: 0.39, 95% CI: 0.26–0.56), diabetes mellitus (HR: 4.89, 95% CI: 3.78–6.32), horizontal ST depression ≥1 mm (HR: 2.86, 95% CI: 1.98–4.15), peak exercise average E/e' ratio (HR: 1.08, 95% CI: 1.06–1.10), and peak exercise wall motion score index (HR: 1.79, 95% CI: 1.36–2.35) were independently correlated with outcome. Conclusions: Patients with concave-shaped chest wall (MHI >2.5) have a significantly lower probability of CV events than those with normal chest shape (MHI ≤2.5) over a medium-term follow-up. A noninvasive chest shape assessment could identify subjects at lower risk of CV events.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, San Giuseppe MultiMedica Hospital, Milan, Italy
| | | | | | - Michele Lombardo
- Department of Cardiology, San Giuseppe MultiMedica Hospital, Milan, Italy
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Vamvakidou A, Danylenko O, Pradhan J, Kelshiker M, Jones T, Whiteside D, Sethi A, Senior R. Relative clinical value of coronary computed tomography and stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis. Eur Heart J Cardiovasc Imaging 2020:jeaa303. [PMID: 33232454 DOI: 10.1093/ehjci/jeaa303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS The European Society of Cardiology recommends coronary computed tomography (CCT) for the assessment of low-risk patients with suspected stable angina. We aimed to assess in a real-life setting the relative clinical value of stress echocardiography (SE)- and CCT-guided management in this population. METHODS AND RESULTS Patients with stable chest pain and no prior history of coronary artery disease (CAD) who underwent CCT or SE as the initial investigative strategy were propensity-matched (990 patients each group-age: 59 ± 13.2 years, males: 47.9%) to account for baseline differences in cardiovascular risk factors. Inconclusive tests were 6% vs. 3% (P < 0.005) in CCT vs. SE. Severe (≥70% stenosis) on CCT and inducible ischaemia on SE detected obstructive CAD by invasive coronary angiography in 63% vs. 57% patients (P = 0.33). Over the follow-up period (median 717, interquartile range 93-1069 days) more patients underwent invasive coronary angiography (21.5% vs. 7.3%, P < 0.005), revascularization (7.3% vs. 3.5%, P < 0.005), further functional testing 33.4% vs. 8.7% (P < 0.005), but more patients were prescribed statins 8.8% vs. 3.8% (P < 0.005) in the CCT vs. the SE arm, respectively. Combined all-cause mortality and acute myocardial infarction was low-CCT-2.3% and SE-3.3%-with no significant difference (P = 0.16). CONCLUSION Initial SE-guided management was similar for the detection of obstructive CAD, demonstrated better resource utilization, but was associated with reduced prescription of statins although with no difference in medium-term outcome compared to CCT in this very low-risk population. However, a randomized study with longer follow-up is needed to confirm the clinical value of our findings.
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Affiliation(s)
- Anastasia Vamvakidou
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
- The Royal Brompton Hospital, Sydney Street, Chelsea, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
| | - Oleksandr Danylenko
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
- The Royal Brompton Hospital, Sydney Street, Chelsea, SW3 6NP, UK
| | - Jiwan Pradhan
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
| | - Mihir Kelshiker
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
| | - Timothy Jones
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
| | - David Whiteside
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
| | - Amarjit Sethi
- National Heart and Lung Institute, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
- The Ealing Hospital, Uxbridge Road, Southall, UB1 3HW, UK
| | - Roxy Senior
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
- The Royal Brompton Hospital, Sydney Street, Chelsea, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
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Samiei N, Parsaee M, Pourafkari L, Tajlil A, Pasbani Y, Rafati A, Nader ND. The value of negative stress echocardiography in predicting cardiovascular events among adults with no known coronary disease. J Cardiovasc Thorac Res 2019; 11:85-94. [PMID: 31384401 PMCID: PMC6669423 DOI: 10.15171/jcvtr.2019.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/19/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction: Stress echocardiography is a safe and cost-effective method of evaluating the patients with suspected coronary artery disease (CAD). However, the risk factors of an adverse cardiovascular event after a normal exercise (ESE) or dobutamine (DSE) stress echocardiography are not well established.
Methods: A cohort of 705 patients without previous history of CAD and a negative ESE/DSE was studied. All studies were performed in a high-volume echocardiologic laboratory and interpreted by two experienced echocardiography-trained cardiologists. Patients with inconclusive studies and those with an evidence of myocardial ischemia were excluded. Demographic, echocardiographic and hemodynamic findings were recorded. Patients were followed for at least 2 years. Independent predictors of major adverse cardiovascular events (MACE) were determined by regression analysis.
Results: During a period of 55.7±17.5 months, MACE occurred in 35 (5.0%) of patients. Negative predictive value (NPV) of DSE was 89.2%, which was significantly less than 96.5% for ESE in predicting the occurrence of MACE (P = 0.001). MACE occurred more frequently among older (≥65 years) men with preexisting diabetes, hypertension, and/or hyperlipidemia. During ESE, a higher maximum blood pressure*heart rate product for the achieved level of metabolic equivalent (METS) of tasks was also an independent predictor of MACE.
Conclusion: Inability of patients to undergo traditional ESE that led to the choice of using DSE alternative reduces the NPV of the stress echocardiography among patients without previous history of CAD. A modest rise of heart rate and blood pressure in response to increased level of activity serves as favorable prognostic value and improves the NPV of stress echocardiography.
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Affiliation(s)
- Niloufar Samiei
- Heart Valve Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
| | - Mozhgan Parsaee
- Echocardiography Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
| | - Leili Pourafkari
- Echocardiography Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran.,Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Arezou Tajlil
- Echocardiography Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
| | - Yeganeh Pasbani
- Heart Valve Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
| | - Ali Rafati
- Heart Valve Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
| | - Nader D Nader
- Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY, USA
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Peteiro J, Bouzas-Mosquera A. Exercise echocardiography. World J Cardiol 2010; 2:223-32. [PMID: 21160588 PMCID: PMC2998822 DOI: 10.4330/wjc.v2.i8.223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 08/01/2010] [Accepted: 08/08/2010] [Indexed: 02/06/2023] Open
Abstract
Exercise echocardiography has been used for 30 years. It is now considered a consolidated technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). Of the stress echocardiography techniques, it represents the first choice for patients who are able to exercise. Given that the cost-effectiveness and safety of stress echocardiography are higher than those of other imaging techniques, its use is likely to be expanded further. Recent research has also proposed this technique for the evaluation of cardiac pathology beyond CAD. Although the role of new technology is promising, the assessment of cardiac function relies on good quality black and white harmonic images.
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Affiliation(s)
- Jesus Peteiro
- Jesus Peteiro, Alberto Bouzas-Mosquera, Laboratory of Echocardiography, Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, 15011-A Coruña, Spain
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Peteiro J. Ecocardiografía de estrés en pacientes con infarto agudo de miocardio. ¿Cuál es la extensión de la enfermedad coronaria y cómo evaluarla? Rev Esp Cardiol (Engl Ed) 2006. [DOI: 10.1157/13089738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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