Abnormal LVCR (<2.0) doubled the risk of severe CAD (38.9% vs 18.9%, RR 2.08, p < 0.001) and improved CAD detection AUC to 0.728 vs 0.532 for wall motion alone.
Does the addition of Left Ventricular Contractile Reserve (LVCR) to stress echocardiography improve the diagnostic accuracy for detecting significant coronary artery disease?
Incorporating Left Ventricular Contractile Reserve (LVCR) into stress echocardiography significantly improves the diagnostic accuracy for detecting severe coronary artery disease compared to traditional wall motion assessment alone.
Abstract Background Wall motion-based assessment in stress echocardiography is a well-established technique in diagnosing coronary artery disease (CAD). Over the years, this, however, showed declining predictive value, hence the recommendation to implement the ABCDE stress echocardiogram protocol. Left ventricular contractile reserve (LVCR), a volumetric component in the protocol, is a derived index of force that is more accurate than ejection fraction. It is measured as the peak systolic blood pressure ratio to end systolic volume at stress and rest. This study aimed to determine the association between LVCR and significant CAD. Methodology Using an analytical cross-sectional design, we reviewed 90 patients who underwent stress echocardiography within six months before elective coronary angiography. Results and Discussion The findings demonstrated that patients with abnormal LVCR (2.0) were significantly more likely to have severe CAD (38.9% vs 18.9%, RR 2.08, p 0.001) compared to those with normal LVCR. Abnormal LVCR was significantly associated with older age (65.2 ± 10.3 vs 58.2 ± 11.2, p 0.003) and diabetes mellitus. In terms of stress parameters, peak heart rate (128 ± 21.3 vs 73.5 ± 12.9, p 0.002) and peak ejection fraction (65.0 ± 12.1 vs 71.5 ± 7.9, p 0.004) were significantly lower in the abnormal LVCR group. Receiver operating characteristic (ROC) curve analysis indicated that an LVCR cutoff of 2.03 provided the best discrimination for normal coronary arteries, while lower cutoffs showed reduced accuracy in differentiating CAD severity. Combining LVCR with traditional wall motion assessment improved diagnostic accuracy in detecting CAD compared to traditional wall motion assessment alone (Sn 44.7%, Sp 80%, AUC 0.728 vs Sn 23.7%, Sp 82.7%, AUC 0.532) suggesting its potential for enhanced detection and risk stratification. Conclusion These results underscore the clinical relevance of LVCR as a simple, objective, and reproducible measure that may improve the detection of significant CAD. Future studies should explore whether LVCR-guided management strategies can optimize diagnostic workflows and patient outcomes in non-invasive CAD assessment.
Hemedez et al. (2025) studied this question. Abnormal LVCR (<2.0) doubled the risk of severe CAD (38.9% vs 18.9%, RR 2.08, p < 0.001) and improved CAD detection AUC to 0.728 vs 0.532 for wall motion alone.