Key result
An exercise-induced increase in E/E' average occurred in 78% of patients with obstructive CAD compared to 24% without CAD, and was independently associated with obstructive CAD (OR 8.1, P<0.001).
Why the study?
Do exercise-induced changes in E/E' ratio help in the detection of obstructive coronary artery disease in patients with suspected CAD?
Observational (n=114)
Do exercise-induced changes in E/E' ratio help in the detection of obstructive coronary artery disease in patients with suspected CAD?
Odds Ratio: 8.1
Absolute Event Rate: 78% vs 24%
p-value: p=<0.001
Exercise-induced increases in the E/E' ratio measured by tissue Doppler echocardiography are strongly associated with obstructive coronary artery disease and may aid in its non-invasive detection.
May support noninvasive CAD detection via exercise E/E'; leaves open prospective validation before clinical adoption.
OBJECTIVES: Ischemia affects the left ventricular (LV) diastolic function earlier than the systolic function. The ratio of the early diastolic transmitral velocity to the early diastolic tissue velocity (E/E') measured by tissue Doppler echocardiography allows a reliable assessment of the diastolic function. We investigated whether exercise-induced changes in E/E' ratio may help in the detection of coronary artery disease (CAD). METHODS: The study population consisted of 114 patients undergoing coronary angiography. Patients with impaired LV ejection fraction, earlier myocardial infarction, arterial hypertension greater than stage I, or LV hypertrophy were excluded. Patients underwent a treadmill exercise test combined with an echocardiogram at baseline and within the first minute after exercise. RESULTS: Coronary angiography showed a stenosis more than 70% in 72 (63%) patients (CAD group), the remaining 42 formed the non-CAD group. The two groups did not differ regarding age, sex, LV dimensions, and function. At baseline, the E/E' lateral and septal ratios and their average did not differ between the two groups. The exercise-induced changes of the E/E' ratios were higher in the CAD group (change of E/E' average: 1.9+/-3.3 vs. -1.1+/-2.3, P<0.001). In the CAD group, 78% showed an exercise-induced increase of E/E' average compared with 24% in the non-CAD group (P<0.001). In multivariate analysis, the association between an increase of E/E' average and the presence of obstructive CAD was independent of traditional risk factors, exercise test result or exercise-induced wall motion abnormalities (odds ratio=8.1, P<0.001). CONCLUSION: Exercise-induced changes in E/E' ratio may offer significant assistance in the detection of CAD.
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Tsougos et al. (2008) conducted an observational in suspected coronary artery disease (n=114). Obstructive coronary artery disease (>70% stenosis) vs. Non-obstructive CAD was evaluated on Exercise-induced increase of E/E' average (OR 8.1, p=<0.001). An exercise-induced increase in E/E' average occurred in 78% of patients with obstructive CAD compared to 24% without CAD, and was independently associated with obstructive CAD (OR 8.1, P<0.001).
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