Incremental value of subclinical left ventricular systolic dysfunction for the identification of patients with obstructive coronary artery disease

Nucifora, Gaetano, Schuijf, Joanne D., Delgado, Victoria, Bertini, Matteo, Scholte, Arthur J. H. A., Ng, Arnold C. T., van Werkhoven, Jacob M., Jukema, J. Wouter, Holman, Eduard R., van der Wall, Ernst E. and Bax, Jeroen J. (2010) Incremental value of subclinical left ventricular systolic dysfunction for the identification of patients with obstructive coronary artery disease. American Heart Journal, 159 1: 148-157. doi:10.1016/j.ahj.2009.10.030


Author Nucifora, Gaetano
Schuijf, Joanne D.
Delgado, Victoria
Bertini, Matteo
Scholte, Arthur J. H. A.
Ng, Arnold C. T.
van Werkhoven, Jacob M.
Jukema, J. Wouter
Holman, Eduard R.
van der Wall, Ernst E.
Bax, Jeroen J.
Title Incremental value of subclinical left ventricular systolic dysfunction for the identification of patients with obstructive coronary artery disease
Journal name American Heart Journal   Check publisher's open access policy
ISSN 0002-8703
1097-6744
Publication date 2010-01
Sub-type Article (original research)
DOI 10.1016/j.ahj.2009.10.030
Volume 159
Issue 1
Start page 148
End page 157
Total pages 10
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Formatted abstract
Background Left ventricular (LV) diastolic dysfunction and subclinical systolic dysfunction may be markers of coronary artery disease (CAD). However, whether these markers are useful for prediction of obstructive CAD is unknown.
Methods A total of 182 consecutive outpatients (54 ± 10 years, 59% males) without known CAD and overt LV systolic dysfunction underwent 64-slice multislice computed tomography (MSCT) coronary angiography and echocardiography. The MSCT angiograms showing atherosclerosis were classified as showing obstructive (≥50% luminal narrowing) CAD or not. Conventional echocardiographic parameters of LV systolic and diastolic function were obtained; in addition, (1) global longitudinal strain (GLS) and strain rate (indices of systolic function) and (2) global strain rate during the isovolumic relaxation period and during early diastolic filling (indices of diastolic function) were assessed using speckle-tracking echocardiography. In addition, the pretest likelihood of obstructive CAD was assessed using the Duke Clinical Score.
Results Based on MSCT, 32% of patients were classified as having no CAD, whereas 33% showed nonobstructive CAD and the remaining 35% had obstructive CAD. Multivariate analysis of clinical and echocardiographic characteristics showed that only high pretest likelihood of CAD (odds ratio [OR] 3.21, 95% 1.02-10.09, P = .046), diastolic dysfunction (OR 3.72, 95% CI 1.44-9.57, P = .006), and GLS (OR 1.97, 95% CI 1.43-2.71, P < .001) were associated with obstructive CAD. A value of GLS ≥−17.4 yielded high sensitivity and specificity in identifying patients with obstructive CAD (83% and 77%, respectively), providing a significant incremental value over pretest likelihood of CAD and diastolic dysfunction.
Conclusions The GLS impairment aids detection of patients without overt LV systolic dysfunction having obstructive CAD.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: School of Medicine Publications
Centre for Advanced Imaging Publications
 
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Created: Mon, 15 Apr 2013, 00:05:19 EST by Dr Chin Tse Arnold Ng on behalf of Centre for Advanced Imaging