Key result
Low septal e´ velocity (<7 cm/s) was independently associated with obstructive coronary artery disease (OR 1.91; 95% CI 1.08-3.36; P=0.026) and improved the diagnostic value of treadmill testing.
Why the study?
Guidelines emphasize four indicators for LV diastolic dysfunction, but their relationships with obstructive CAD were not determined.
Do echocardiographic diastolic parameters, specifically septal e´ velocity, predict the presence of obstructive coronary artery disease in stable patients with normal LVEF?
Observational (n=1,307)
Yes
Do echocardiographic diastolic parameters, specifically septal e´ velocity, predict the presence of obstructive coronary artery disease in stable patients with normal LVEF?
Odds Ratio: 1.91 (95% CI 1.08–3.36)
p-value: p=0.026
In stable patients with normal LVEF suspected of having CAD, a low septal e´ velocity (<7 cm/s) on echocardiography is an independent predictor of obstructive CAD and improves the diagnostic yield of treadmill exercise testing.
May aid CAD suspicion in stable patients with normal LVEF; leaves open prospective validation of added diagnostic value.
BACKGROUND: A recent guideline emphasizes the role of four indicators, including annular e´ velocity, E/e´, left atrial (LA) size, and peak tricuspid regurgitation (TR) velocity, in the assessment of left ventricular (LV) diastolic dysfunction. This study was performed to determine the relationships among these four parameters and obstructive coronary artery disease (CAD). METHODS: The study data were obtained from a nation-wide registry, composed of 1307 patients (age, 60.4 ± 10.8 years; 964 women) with normal LV ejection fraction (LVEF) who underwent invasive coronary angiography in the suspicion of CAD. Septal e´, E/e´, LA dimension (LAd), and TR velocity were assessed by transthoracic echocardiography. RESULTS: Compared with patients without obstructive CAD, those with obstructive CAD showed changes in diastolic parameters indicating more progressed LV diastolic dysfunction in univariate analyses. In multiple logistic regression analysis, low septal e´ velocity (<7 cm/s) was identified as an independent risk factor associated with obstructive CAD (odd ratio, 1.91; 95% confidence interval, 1.08-3.36; P = 0.026). Receiver-operating characteristic curve analysis showed that septal e´ velocity had the most powerful value in the detection of obstructive CAD than the other three diastolic parameters (P < 0.01 for each comparison). Septal e´ velocity significantly increased diagnostic value of treadmill exercise test (TET) in the detection of obstructive CAD (P < 0.001 for integrated discrimination improvement index). CONCLUSIONS: Among the four diastolic parameters, septal e´ velocity had the most powerful relationship with obstructive CAD in stable patients with normal LVEF. The addition of septal e´ velocity could improve the diagnostic value of TET.
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Kim et al. (2020) conducted an observational in Obstructive coronary artery disease (n=1,307). Low septal e´ velocity (<7 cm/s) vs. Normal septal e´ velocity was evaluated on Obstructive CAD (OR 1.91, 95% CI 1.08-3.36, p=0.026). Low septal e´ velocity (<7 cm/s) was independently associated with obstructive coronary artery disease (OR 1.91; 95% CI 1.08-3.36; P=0.026) and improved the diagnostic value of treadmill testing.
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