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THE DIAGNOSTIC VALUE OF STRESS ECHOCARDIOGRAPHY AND ELECTROCARDIOGRAPHY IN IDENTIFYING OCCULT CORONARY ABNORMALITIES IN PATIENTS WITH ANGINA AND NO OBSTRUCTIVE CORONARY ARTERY DISEASE
A1623 JACC March 17, 2015 Volume 65, Issue 10S
Stable Ischemic Heart Disease The Diagnostic Value of Stress Echocardiography and Electrocardiography in Identifying Occult Coronary Abnormalities in Patients with Angina and No Obstructive Coronary Artery Disease Poster Contributions Poster Hall B1 Saturday, March 14, 2015, 3:45 p.m.-4:30 p.m. Session Title: Stress Testing and Coronary Imaging Abstract Category: 26. Stable Ischemic Heart Disease: Clinical Presentation Number: 1160-372 Authors: Vedant Pargaonkar, Abha Khandelwal, Yuhei Kobayashi, Shigemitsu Tanaka, Maya B. Mathur, Victor Froelicher, Alan Yeung, Jennifer Tremmel, Stanford University School of Medicine, Stanford, CA, USA, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
Background: While >20% of patients presenting to the cath lab with angina have no obstructive CAD, a majority (77%) have occult coronary abnormalities (endothelial dysfunction, microvascular dysfunction (MVD), and myocardial bridging (MB)), which may explain their symptoms. The ability of stress echocardiogram (echo) and electrocardiogram (ECG) to identify patients with these abnormalities is unknown.
Methods: We evaluated 108 patients (72% women) with angina and no obstructive CAD. All had stress echo and ECG, followed by invasive testing for endothelial dysfunction (decrease in luminal diameter of >20% with intracoronary acetylcholine), MVD (index of microcirculatory resistance ≥25), and MB (echolucent half-moon sign and/or ≥10% systolic compression on intravascular ultrasound). A positive stress echo and ECG were defined as a new segmental wall motion abnormality and ≥1mm horizontal or downsloping ST-segment depression, respectively. Results: Stress echo was positive in 32 (29%) patients and stress ECG was positive in 29 (27%). Endothelial dysfunction was present in 62 (57%), MVD in 16 (15%), and MB in 60 (55%). Neither echo nor ECG during stress predicted endothelial dysfunction, MVD, or MB (Table).
Conclusion: Conventional stress testing is insufficient for identifying occult coronary abnormalities which are frequently present in patients with angina and no obstructive CAD. Even with a normal stress test, further testing may be needed to gain important diagnostic information. Uni-variable logistic regression analysis for the diagnostic value of stress echo and ECG Abnormality
Endothelial dysfunction
Microvascular dysfunction
Myocardial bridging
p value
Sensitivity
Specificity
Positive Predictive Value
Negative Predictive Value
positive stress echo 1.35 (0.58 - 3.14)
0.69
32.2%
73.9%
62.5%
44.7%
positive stress ECG 1.30 (0.54 - 3.11)
0.59
29.0%
76.0%
62.0%
44.3%
positive stress echo 1.09 (0.34 - 3.45)
0.15
31.2%
70.6%
15.6%
85.5%
positive stress ECG 0.58 (0.15 - 2.22)
0.43
18.7%
71.7%
10.3%
83.5%
positive stress echo 1.04 (0.45 - 2.39)
0.92
30.0%
70.8%
56.2%
44.7%
positive stress ECG 0.67 (0.28 - 1.57)
0.35
23.3%
68.7%
48.3%
41.7%
Predictor
Odd’s Ratio (95% Confidence Interval)
Stable Ischemic Heart Disease The Diagnostic Value of Stress Echocardiography and Electrocardiography in Identifying Occult Coronary Abnormalities in Patients with Angina and No Obstructive Coronary Artery Disease Poster Contributions Poster Hall B1 Saturday, March 14, 2015, 3:45 p.m.-4:30 p.m. Session Title: Stress Testing and Coronary Imaging Abstract Category: 26. Stable Ischemic Heart Disease: Clinical Presentation Number: 1160-372 Authors: Vedant Pargaonkar, Abha Khandelwal, Yuhei Kobayashi, Shigemitsu Tanaka, Maya B. Mathur, Victor Froelicher, Alan Yeung, Jennifer Tremmel, Stanford University School of Medicine, Stanford, CA, USA, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
Background: While >20% of patients presenting to the cath lab with angina have no obstructive CAD, a majority (77%) have occult coronary abnormalities (endothelial dysfunction, microvascular dysfunction (MVD), and myocardial bridging (MB)), which may explain their symptoms. The ability of stress echocardiogram (echo) and electrocardiogram (ECG) to identify patients with these abnormalities is unknown.
Methods: We evaluated 108 patients (72% women) with angina and no obstructive CAD. All had stress echo and ECG, followed by invasive testing for endothelial dysfunction (decrease in luminal diameter of >20% with intracoronary acetylcholine), MVD (index of microcirculatory resistance ≥25), and MB (echolucent half-moon sign and/or ≥10% systolic compression on intravascular ultrasound). A positive stress echo and ECG were defined as a new segmental wall motion abnormality and ≥1mm horizontal or downsloping ST-segment depression, respectively. Results: Stress echo was positive in 32 (29%) patients and stress ECG was positive in 29 (27%). Endothelial dysfunction was present in 62 (57%), MVD in 16 (15%), and MB in 60 (55%). Neither echo nor ECG during stress predicted endothelial dysfunction, MVD, or MB (Table).
Conclusion: Conventional stress testing is insufficient for identifying occult coronary abnormalities which are frequently present in patients with angina and no obstructive CAD. Even with a normal stress test, further testing may be needed to gain important diagnostic information. Uni-variable logistic regression analysis for the diagnostic value of stress echo and ECG Abnormality
Endothelial dysfunction
Microvascular dysfunction
Myocardial bridging
p value
Sensitivity
Specificity
Positive Predictive Value
Negative Predictive Value
positive stress echo 1.35 (0.58 - 3.14)
0.69
32.2%
73.9%
62.5%
44.7%
positive stress ECG 1.30 (0.54 - 3.11)
0.59
29.0%
76.0%
62.0%
44.3%
positive stress echo 1.09 (0.34 - 3.45)
0.15
31.2%
70.6%
15.6%
85.5%
positive stress ECG 0.58 (0.15 - 2.22)
0.43
18.7%
71.7%
10.3%
83.5%
positive stress echo 1.04 (0.45 - 2.39)
0.92
30.0%
70.8%
56.2%
44.7%
positive stress ECG 0.67 (0.28 - 1.57)
0.35
23.3%
68.7%
48.3%
41.7%
Predictor
Odd’s Ratio (95% Confidence Interval)