A concave-shaped chest wall (Modified Haller Index > 2.5) was independently associated with a significantly lower risk of cardiovascular events compared to a normal chest shape (HR 0.39).
Cohort (n=1,091)
No
Does a concave-shaped chest wall (MHI > 2.5) predict a lower probability of cardiovascular events in patients with suspected coronary artery disease referred for exercise stress echocardiography?
A noninvasive chest shape assessment using the Modified Haller Index can identify subjects at lower risk of cardiovascular events among those with suspected CAD.
Hazard Ratio: 0.39 (95% CI 0.26–0.56)
p-value: p=<0.0001
BACKGROUND: The influence of chest conformation on outcome of patients with suspected coronary artery disease (CAD) is actually unknown. MATERIALS AND METHODS: This retrospective study included all consecutive patients who underwent exercise stress echocardiography (ESE) for suspected CAD at our institution between February 2011 and September 2019. Modified Haller index (MHI; chest transverse diameter over the distance between sternum and spine) was assessed in all patients. Obstructive CAD was diagnosed by ≥70% stenosis in any epicardial coronary artery. During the follow-up time, we evaluated the occurrence of any of the following: (1) cardiovascular (CV) hospitalizations and (2) cardiac death or sudden death. RESULTS: A total of 1091 consecutive patients (62.4 ± 12.6 years, 57.2% of men) were included in the study. Patients with normal chest shape (MHI ≤2.5) and those with concave-shaped chest wall (MHI >2.5) were separately analyzed. A positive ESE was diagnosed in 171 patients of which 80.7% had an obstructive CAD (true positive), while 19.3 not (false positive FP). Majority of FP ESE (70.9%) derived from concave-shaped chest wall group. During follow-up time (2.5 ± 1.9 years), 9 patients died and 281 were hospitalized because of heart failure (163), acute coronary syndromes (39), and arrhythmias (79). At the multivariate Cox regression analysis, age (heart rate HR: 1.02, 95% confidence interval CI: 1.01-1.03), MHI >2.5 (HR: 0.39, 95% CI: 0.26-0.56), diabetes mellitus (HR: 4.89, 95% CI: 3.78-6.32), horizontal ST depression ≥1 mm (HR: 2.86, 95% CI: 1.98-4.15), peak exercise average E/e' ratio (HR: 1.08, 95% CI: 1.06-1.10), and peak exercise wall motion score index (HR: 1.79, 95% CI: 1.36-2.35) were independently correlated with outcome. CONCLUSIONS: Patients with concave-shaped chest wall (MHI >2.5) have a significantly lower probability of CV events than those with normal chest shape (MHI ≤2.5) over a medium-term follow-up. A noninvasive chest shape assessment could identify subjects at lower risk of CV events.
Sonaglioni et al. (Thu,) conducted a cohort in Suspected coronary artery disease (n=1,091). Concave-shaped chest wall (Modified Haller Index > 2.5) vs. Normal chest shape (Modified Haller Index ≤ 2.5) was evaluated on Cardiovascular events (cardiovascular hospitalizations, cardiac death, or sudden death) (HR 0.39, 95% CI 0.26-0.56, p=<0.0001). A concave-shaped chest wall (Modified Haller Index > 2.5) was independently associated with a significantly lower risk of cardiovascular events compared to a normal chest shape (HR 0.39).
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