Improving Stress Echocardiography for Enhanced Detection of Left Main and Multivessel Coronary Artery Disease

Figures

• 

  Figure 1. Flowchart of patient selection for analyses. Total patient population was used to evaluate for baseline demographic characteristics. Correlation and regression analyses were undertaken after excluding patients who have not reached the threshold for ischemia as defined by heart rate (HR) ≥ 85% for age at peak of stress. ACS, acute coronary syndrome; ICA, invasive coronary angiography.

• 

  Figure 2. Diagnostic performance of stress echocardiography for identifying lesions in the 3 coronary vessels, based on wall-motion abnormality. Sensitivity and specificity of stress echocardiography-based wall-motion abnormality in detecting coronary vessel disease when compared to invasive coronary angiogram. LAD, left anterior descending; LCX, left circumflex; RCA, right coronary artery.

• 

  Figure 3. Improvement of diagnostic performance of stress echocardiography (SE) in identifying high-risk anatomy (left main disease [LMD] and/or 3-vessel disease [3VD]). (A) Sensitivity, specificity, negative predictive value, and positive predictive value of standard SE in comparison to a new model integrating Δ GLS ≥ 5% for enhanced detection of LMD and/or 3VD. (B) Receiver operating characteristics demonstrating the accuracy of Δ GLS for subsequently identifying 3VD and/or LMD on invasive coronary angiography. (C) Receiver operating characteristics evaluating the accuracy of a new model integrating Δ GLS ≥ 5% to standard SE for detecting 3VD and/or LMD, compared to standard SE alone (area under the curve 0.807 vs 0.774, respectively; P = 0.287). GLS, global longitudinal strain.

• 

  Central Illustration. Improvement of diagnostic performance of stress echocardiography (SE) in identifying high-risk anatomy (left main disease [LMD] and/or 3-vessel disease [3VD]). (A) Flow chart of the study population based on inclusion and exclusion criteria. (B) Sensitivity, specificity, negative predictive value, and positive predictive value of standard SE in comparison to a new model integrating Δ GLS ≥ 5% for enhanced detection of LMD and/or 3VD. (C) Receiver operating characteristics demonstrating the accuracy of Δ GLS for subsequently identifying 3VD and/or LMD on invasive coronary angiography (ICA). (D) Receiver operating characteristics evaluating the accuracy of a new model integrating Δ GLS ≥ 5% to standard SE for detecting 3VD and/or LMD, compared to standard SE alone (area under the curve [AUC] 0.807 vs 0.774, respectively, P = 0.287). Δ GLS is defined as the difference between global longitudinal strain (GLS) at peak of stress and GLS at rest. ACS, acute coronary syndrome; GLS, global longitudinal strain; HR, heart rate; OR, odds ratio.