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Left Atrial Volume Index at Peak Dobutamine Stress Echocardiography Predicts the Extent of Coronary Artery Disease in Patients with Normal Resting Wall Motion
Author(s) -
AbdelSalam Zainab,
ElHammady Walid,
AbdelSattar Ahmed,
Nammas Wail
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.12946
Subject(s) - coronary artery disease , cardiology , medicine , dobutamine , cutoff , stenosis , stress echocardiography , coronary angiography , area under the curve , cad , body surface area , receiver operating characteristic , hemodynamics , myocardial infarction , physics , quantum mechanics , engineering drawing , engineering
Background Left atrial volume indexed to body surface area ( LAVI ) measured at rest is an independent predictor of adverse cardiovascular outcome at long‐term follow‐up. We explored the value of LAVI measured at peak dobutamine stress echocardiography ( DSE ) to identify patients with significant coronary artery disease ( CAD ) and to discriminate those with multivessel CAD . Methods We enrolled 100 patients of 134 consecutively screened patients without resting wall‐motion abnormalities ( WMA ) referred for DSE . LA volume was measured using the biplane area–length method at rest and at peak DSE . Significant coronary stenosis was defined as ≥50% obstruction of ≥1 sizable artery by coronary angiography. Results The mean age was 57.2 ± 10.6 years (55% males). Fifty‐six patients (56%) had significant CAD by coronary angiography: 28 (28%) had single‐vessel CAD , and 28 (28%) had multivessel CAD . ROC curve analysis showed that the optimal cutoff value of stress‐induced LAVI that best discriminates significant CAD was 30.1 mL/m 2 . Using this cutoff value, significant CAD was identified with a sensitivity of 85.7%, specificity 95.5%, PPV 96%, and NPV 84%. The optimal cutoff value of stress‐induced LAVI that best discriminates multivessel CAD was 32.7 mL/m 2 . Using this cutoff value, multivessel CAD was identified with a sensitivity of 88.7%, specificity 96.5%, PPV 97%, and NPV 89%. Conclusions In symptomatic patients who underwent DSE for suspected CAD and had no resting WMA , LAVI measured at peak DSE predicted angiographically significant CAD with acceptable sensitivity and high specificity and predicted multivessel CAD with high sensitivity and specificity.