Abstract
Background
Dypiridamol stress echocardiography (DSE) is an important tool for detecting reversible ischemia in patients with suspected coronary artery disease (CAD); nonetheless the results of the test are related to visualization of wall motion abnormalities, moderately operator-dependent, and left anterior descending (LAD) artery reserve, resulting in a moderate sensibility and specificity. Aim of our study was to evaluate whether an an easy-to-use parameter like mitral annular plane systolic excursion (MAPSE) could be useful to identify CAD during DSE.
Methods
We prospectively enrolled 300 patients with suspected CAD and perform a DSE; at rest and peak MAPSE was acquired. 59 patients with reversibile ischemia during stress echocardiography (positive) were referred to perform coronary angiography. Patients were divided according to MAPSE behaviour during DSE: group 1 (MAPSE ≤ 0) and group 2 (delta MAPSE > 0 mm).
Results
The mean age of was 63 ± 11 years, male gender was prevalent (73%); no differences were found in risk factors and left vetnricular ejection fraction (LV-EF) between two groups.Coronary arteries were normal in 14 patients (23%), while significant stenosis (>70%) was found in 45 patients (77%); in 31 patients (53%) left main (LM) or proximal LAD artery were involved, while in 17 (29%) and 22 (37%) right coronary artery and circumflex artery were affected respectively. Patients with CAD showed a lower (blunted or no increase) MAPSE after dypiridamole infusion, with a significative difference in Delta Mapse (Mapse peak-Mapse rest) between groups (0,2 mm vs 2,8 mm p = 0,004) (Figure 1B). By using a Receiver Operating Curve, the Area under the curve was 0,757, with the best cut-off value for CAD prediction at Delta Mapse= +2.5 mm (sensibility 0,667 and specificity 0,809 – p = 0.012 - Figure 1b). In particular, Delta Mapse was able to predict LM/LAD stenosis (Figure 1B AUC = 0.679 ;p = 0.019), rather than right coronary artery and circumflex artery disease, with higher predictivity than delta LV-EF (AUC = 0.577; p = 0.077).
Discussion
To our knowledge, this is the first study that compared the behaviour of MAPSE during dypiridamole infusion in patient with and withouth coronary artery disease. MAPSE is a well-known surrogate of longitudinal systolic function and have increased sensitivity over traditional methods of systolic performance such as LV-EF; in this context, dypiridamole induced reversible ischemia could affect prematurely MAPSE then EF or wall motion abnormalities. In our study, in patients with evidence of reversible ischemia during DSE, a blunted or no increase of MAPSE was able to predict CAD, mostly driven by LM/LAD disease, on top of other well known markers of ischemia. Incorporating this easy-to-use parameter could improve specificity of DSE and strenghten the suspect of reversibile ischemia when clear wall motion abnormalities are not found.
Abstract P1555 Figure 1A and 1B
704 Stress echocardiography: myocardial work ‘works’
