Left Atrial Volume Index at Peak Dobutamine Stress Echocardiography Predicts the Extent of Coronary Artery Disease in Patients with Normal Resting Wall Motion

BACKGROUND: Left atrial volume indexed to body surface area (LAVI) measured at rest is an independent predictor of adverse cardiovascular outcome at long-term follow-up. We explored the value of LAVI measured at peak dobutamine stress echocardiography (DSE) to identify patients with significant coronary artery disease (CAD) and to discriminate those with multivessel CAD. METHODS: We enrolled 100 patients of 134 consecutively screened patients without resting wall-motion abnormalities (WMA) referred for DSE. LA volume was measured using the biplane area-length method at rest and at peak DSE. Significant coronary stenosis was defined as ≥50% obstruction of ≥1 sizable artery by coronary angiography. RESULTS: The mean age was 57.2 ± 10.6 years (55% males). Fifty-six patients (56%) had significant CAD by coronary angiography: 28 (28%) had single-vessel CAD, and 28 (28%) had multivessel CAD. ROC curve analysis showed that the optimal cutoff value of stress-induced LAVI that best discriminates significant CAD was 30.1 mL/m(2) . Using this cutoff value, significant CAD was identified with a sensitivity of 85.7%, specificity 95.5%, PPV 96%, and NPV 84%. The optimal cutoff value of stress-induced LAVI that best discriminates multivessel CAD was 32.7 mL/m(2) . Using this cutoff value, multivessel CAD was identified with a sensitivity of 88.7%, specificity 96.5%, PPV 97%, and NPV 89%. CONCLUSIONS: In symptomatic patients who underwent DSE for suspected CAD and had no resting WMA, LAVI measured at peak DSE predicted angiographically significant CAD with acceptable sensitivity and high specificity and predicted multivessel CAD with high sensitivity and specificity.