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Value of Resting Echocardiographic Findings and Dobutamine Stress Echocardiography for Diagnosing Myocardial Ischemia in Patients with Suspected Angina Pectoris
Author(s) -
Utsunomiya Hiroto,
Hidaka Takayuki,
Masada Kenji,
Shimonaga Takashi,
Higaki Tadanao,
Iwasaki Toshitaka,
Mitsuba Naoya,
Ishibashi Ken,
Kurisu Satoshi,
Kihara Yasuki
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12800
Subject(s) - medicine , cardiology , dobutamine , angina , diastole , ischemia , fractional flow reserve , coronary artery disease , systole , stress echocardiography , hemodynamics , blood pressure , myocardial infarction , coronary angiography
Background We evaluated the diagnostic value of resting echocardiographic findings including total heart calcification ( THC ) score in combination with dobutamine stress echocardiography ( DSE ) for detection of myocardial ischemia. Methods Altogether, 110 patients with suspected angina pectoris underwent resting echocardiography and DSE . On the basis of resting echocardiography, we determined the THC score, left anterior descending artery diastole‐to‐systole velocity ratio ( LAD ‐ DSVR ), and positive myocardial velocity during isovolumic relaxation phase (V IVR ) detected by color‐coded tissue D oppler imaging. Myocardial ischemia was diagnosed by a 25% or greater reduction in the internal diameter of major coronary vessels with impaired fractional flow reserve ( FFR ≤0.80). Results DSE had excellent specificity (89%) but modest sensitivity (52%) for wall‐motion abnormality ( WMA ) analysis. Multivariate analysis showed that THC score ≥2 (odds ratio and 95% confidence interval: 4.49 [2.29–10.6]; P = 0.018), LAD ‐ DSVR ≤1.5 (6.43 [1.39–20.3], P = 0.019), and duration of positive V IVR ≥71 msec (7.93 [3.72–12.1]; P < 0.001) were independent predictors of ischemia. The combination of inducible WMA and THC score yielded significantly higher sensitivity for ischemia detection than the inducible WMA alone (80% vs. 52%, P = 0.0008). Using receiver operating characteristics analyses, adding all three resting echocardiographic findings to clinical variables plus inducible WMA further improved prediction of ischemia (P = 0.028). Conclusions Integration of DSE and resting echocardiographic findings describing degree of heart calcification, impaired LAD flow, and extent of delayed ejection motion of the myocardium improves detection of coronary angiogram‐based FFR ‐guided ischemia.