The ischemic Bull's-eye pattern showed 93% sensitivity and aortic stiffness (OR 1.02) increased CAD prediction, raising AUC to 0.76 beyond ESC risk factors.
Does the combination of ischemic Bull's-eye pattern on LV GLS and aortic stiffness improve the prediction of physiologically significant CAD compared to ESC clinical risk factor-based likelihood?
The integration of ischemic Bull's-eye pattern on echocardiography and aortic stiffness provides incremental diagnostic value over traditional ESC risk scores for detecting physiologically significant CAD.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Coronary artery disease (CAD) remains a major cause of morbidity and mortality. While resting transthoracic echocardiography (TTE) is widely used, the role of left ventricular global longitudinal strain (LV GLS) in detecting physiologically significant CAD is unclear. According to the 2024 ESC guidelines, clinical likelihood assessment remains fundamental but has limitations in identifying CAD that requires intervention, necessitating improved risk stratification. Purpose To evaluate the diagnostic utility of LV GLS in predicting physiologically significant CAD, confirmed by intracoronary physiological tests such as fractional flow reserve (FFR) and/or non-hyperemic pressure ratios (NHPRs). Methods A retrospective cohort study was conducted at our cardiac center, Thailand, including 207 patients who underwent coronary angiography with FFR and/or NHPRs between August 2018 and September 2024. Resting echocardiograms were reanalyzed for LV GLS patterns. The ischemic Bull’s-eye pattern was defined as a decrease in two consecutive regional strains below -15%. Aortic stiffness was assessed by a central aortic pulse pressure greater than 65 mmHg. Results Among the 207 patients, 99 (47%) had physiologically significant CAD (FFR ≤ 0.80 and/or NHPR ≤ 0.89). Average LV GLS alone was not a strong predictor (area under the curve AUC = 0.56, p = 0.130), but the ischemic Bull’s-eye pattern demonstrated high sensitivity (93%) and negative predictive value (87%). Aortic stiffness was independently associated with physiologically significant CAD (OR 1.02, 95% CI = 1.00–1.04, p = 0.042). The combined model achieved an AUC of 0.76, outperforming both average LV GLS alone and the 2024 ESC clinical risk factor-based likelihood (Figure 1). Conclusion The ischemic Bull’s-eye pattern and aortic stiffness assessment are emerging predictors for physiologically significant CAD (Figure 2), providing incremental diagnostic value beyond traditional risk stratification. Their integration into early CAD screening protocols may enhance diagnostic accuracy and clinical decision-making.ROC analysis Central illustration
Rawangban et al. (Sat,) reported a other. The ischemic Bull's-eye pattern showed 93% sensitivity and aortic stiffness (OR 1.02) increased CAD prediction, raising AUC to 0.76 beyond ESC risk factors.
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