Longitudinal Strain by Automated Function Imaging Detects Single-Vessel Coronary Artery Disease in Patients Undergoing Dipyridamole Stress Echocardiography

Abstract Background The aim of this study was to investigate the incremental value of global longitudinal strain (GLS), postsystolic strain index (PSI) and prestretch (PSE) by automated function imaging with respect to wall motion (WM) and coronary flow reserve (CFR) for the diagnosis of significant coronary artery disease (CAD) during dipyridamole stress echocardiography. Methods We retrospectibely enrolled 227 patients with known or suspected CAD, approaching our echo lab to perform a DSE; all patient underwent coronary angiography within 1 month for clinical reasons. Obstructive CAD was defined as the evidence of >70% stenosis during coronary angiogram. Obstructive CAD was detected in 143 (63%) patients, while 84 (37%) had no significant CAD. Global longitudinal strain, PSI and PSE were measured at rest and peak of the stress (after 6 minutes of 0,84mg/kg of dipyridamole infusion). Results Patient with CAD showed a significantly lower GLS at rest (−16.9±4.2 vs −18.6±3.4; p<0.01) and peak (14.9±3.8 vs −21.50±3.3; p<0.01) Figure A; the behavior of GLS was opposite, in patient with CAD showed an increase while in patient without CAD a significant decrease after dipyridamole infusion. There was also a significant difference between groups for Delta PSI (PSIpeak − PSIrest) and Delta PSE (PSEpeak − PSErest), respectively 126±145 vs −40±97, (p<0.01) and 108±163 vs −41±106 (p<0.01) Figure C. ROC analyses produced a statistically valid model: Average GLS at peak (p 0.001; AUC=0.906, cut-off value −18%, sensitivity 83% and specificity 82%); on the basis of these results, we compared WM and myocardial deformation analysis and GLS was superior to CFR LAD, Delta EF, Delta ESV and Delta WMI (Figure B). Conclusions GLS, PSE and PSI show an opposite response to dipyridamole, in patients with CAD in patient without CAD and show much higher sensitivity and specificity compared to the conventional parameters like WMI, EF and CFR in detecting CAD Funding Acknowledgement Type of funding source: None

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Non-invasive Diagnostic and Prognostic Assessment of Single-vessel Coronary Artery Disease: Focus on Stress Echocardiography

European Journal of Echocardiography ◽

10.1053/euje.2000.0059 ◽

2001 ◽

Vol 2 (1) ◽

pp. 40-45 ◽

Cited By ~ 2

Author(s):

R Bigi

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Echocardiography ◽

Non Invasive ◽

Single Vessel ◽

Vessel Coronary Artery Disease ◽

Prognostic Assessment ◽

Artery Disease ◽

Disease Focus ◽

Vessel Coronary Artery

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Non-invasive Diagnostic and Prognostic Assessment of Single-vessel Coronary Artery Disease: Focus on Stress Echocardiography

European Journal of Echocardiography ◽

10.1016/s1525-2167(00)90059-3 ◽

2001 ◽

Vol 2 (1) ◽

pp. 40-45

Author(s):

R BIGI ◽

L CORTIGIANI ◽

A DESIDERI

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Echocardiography ◽

Non Invasive ◽

Single Vessel ◽

Vessel Coronary Artery Disease ◽

Prognostic Assessment ◽

Artery Disease ◽

Disease Focus ◽

Vessel Coronary Artery

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Cost-effectiveness analysis of percutaneous coronary intervention for single-vessel coronary artery disease: an economic evaluation of the ORBITA trial

BMJ Open ◽

10.1136/bmjopen-2020-044054 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044054

Author(s):

Victoria McCreanor ◽

Alexandra Nowbar ◽

Christopher Rajkumar ◽

Adrian G Barnett ◽

Darrel Francis ◽

...

Keyword(s):

Coronary Artery Disease ◽

Cost Effectiveness ◽

Coronary Artery ◽

Coronary Intervention ◽

Single Vessel ◽

Vessel Coronary Artery Disease ◽

Effectiveness Analysis ◽

Percutaneous Coronary ◽

Artery Disease ◽

Vessel Coronary Artery

ObjectiveTo evaluate the cost-effectiveness of percutaneous coronary intervention (PCI) compared with placebo in patients with single-vessel coronary artery disease and angina despite anti-anginal therapy.DesignA cost-effectiveness analysis comparing PCI with placebo. A Markov model was used to measure incremental cost-effectiveness, in cost per quality-adjusted life-years (QALYs) gained, over 12 months. Health utility weights were estimated using responses to the EuroQol 5-level questionnaire, from the Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina trial and UK preference weights. Costs of procedures and follow-up consultations were derived from Healthcare Resource Group reference costs and drug costs from the National Health Service (NHS) drug tariff. Probabilistic sensitivity analysis was undertaken to test the robustness of results to parameter uncertainty. Scenario analyses were performed to test the effect on results of reduced pharmaceutical costs in patients undergoing PCI, and the effect of patients crossing over from placebo to PCI due to refractory angina within 12 months.SettingFive UK NHS hospitals.Participants200 adult patients with stable angina and angiographically severe single-vessel coronary artery disease on anti-anginal therapy.InterventionsAt recruitment, patients received 6 weeks of optimisation of medical therapy for angina after which they were randomised to PCI or a placebo procedure.Outcome measuresIncremental cost-effectiveness ratio (ICER) expressed as cost (in £) per QALY gained for PCI compared with placebo.ResultsThe estimated ICER is £90 218/QALY gained when using PCI compared with placebo in patients receiving medical treatment for angina due to single-vessel coronary artery disease. Results were robust under sensitivity analyses.ConclusionsThe ICER for PCI compared with placebo, in patients with single-vessel coronary artery disease and angina on anti-anginal medication, exceeds the threshold of £30 000 used by the National Institute of Health and Care Excellence when undertaking health technology assessment for the NHS context.Trial registration: The ORBITA study is registered with ClinicalTrials.gov, number NCT02062593.

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