The diagnostic value of stress echocardiography with limited myocardial ischemia in high-risk patients

Nikolaos P E Kadoglou; Constantinos Η Papadopoulos; Elina Khattab; Nikolaos Velidakis; Stylianos Lambropoulos

doi:10.1016/j.hjc.2023.12.007

The diagnostic value of stress echocardiography with limited myocardial ischemia in high-risk patients

Hellenic J Cardiol. 2024 Jan 3:S1109-9666(23)00233-6. doi: 10.1016/j.hjc.2023.12.007. Online ahead of print.

Authors

Nikolaos P E Kadoglou¹, Constantinos Η Papadopoulos², Elina Khattab³, Nikolaos Velidakis³, Stylianos Lambropoulos⁴

Affiliations

¹ Medical School, University of Cyprus, Nicosia, Cyprus. Electronic address: nikoskad@yahoo.com.
² 2nd Cardiology Department, Korgialenio - Benakio Red Cross Hospital, Athens, Greece.
³ Medical School, University of Cyprus, Nicosia, Cyprus.
⁴ Department of Cardiology, "Mamatsio" General Hospital, Kozani, Greece.

PMID: 38182003
DOI: 10.1016/j.hjc.2023.12.007

Abstract

Background: The diagnostic value of limited myocardial ischemia in DSE is not well known.

Objectives: We investigated whether myocardial ischemia during dobutamine stress echocardiography (DSE) in 1 apical segment of any of the ventricular walls of the left ventricle relates to the anatomical and functional stenosis of the suppling coronary artery.

Methods: Our observational, prospective study enrolled 212 patients, symptomatic or asymptomatic, with newly diagnosed limited myocardial ischemia on DSE. Almost 25% of them had already known CAD, while the rest were divided into low-risk and high-risk groups, integrating 1-2 and ≥3 classical cardiovascular risk factors, respectively. After DSE, all patients underwent invasive coronary angiography (ICA) and were followed up for one year. In coronary arteries distributing ischemic area, the calculated stenosis ≥50% and FFR<0.8 were considered anatomically and functionally significant, respectively. In the latter cases, the patients underwent coronary revascularization.

Results: Significant anatomical and functional stenosis of the supplying coronary artery was common among patients with already known CAD (62.5% and 44.5%, respectively) or those without CAD but a high-risk profile (60.2% and 25.6%, respectively). In logistic regression analysis, CAD revascularization was independently determined by an already known CAD, diabetes mellitus, and high-risk profile. During follow-up, 24 patients experienced ACS or new angina episodes, which were associated with diabetes and smoking in univariate analysis.

Conclusion: Limited myocardial ischemia may implicate significant anatomical and functional coronary stenosis among individuals with a history of CAD or those without known CAD but a high-risk profile. The prognostic value of our findings requires further investigation.

Keywords: coronary artery diseases; functional coronary stenosis; limited myocardial ischemia; stress echocardiography.