Diagnostic and prognostic significance of clinical data and parameters of five-stage stress echocardiography in patients with known and suspected coronary artery disease

Objectives. To study the clinical and diagnostic role of supplemented five-stage stress echocardiography (SE) with physical exercise in patients with known and suspected coronary artery disease (CAD) compared to traditional SE; to analyze the management tactics for patients with suspected CAD depending on the stress test results in combination with clinical data; to assess the contribution of additional SE parameters to the short-term prognosis.

Material and methods. A total of 253 patients (62 (53; 68), 130 (51.4%) men) with known and suspected CAD without a history of MI underwent ABCDE-SE in a single-center study for clinical indications (chest pain, dyspnea, ischemic changes on ECG). The median follow-up period was 198 (118; 324) days. The contribution of additional SE parameters to the diagnosis of significant coronary artery disease and prediction of rehospitalizations (combined endpoint) was studied, and management tactics were analyzed depending on the results of extended SE.

Results. A positive test for the traditional criterion — induced ischemia — was detected in 22 (8.7%) patients; among the additional criteria of ischemia, a decrease in contractile reserve (CR) was most often detected (n = 161; 63.6%). During the observation period, the combined endpoint was registered in 32 (12.7%) patients. In addition to induced ischemia, patients with significant coronary artery disease had lower left ventricular (LV) myocardial efficiency (p = 0.045), LV force under load (p < 0.001), LV SR (p < 0.001), higher SE score (p < 0.001) and more frequent SR decrease (p = 0.005). Most often, coronary angiography was prescribed after a positive step A (72.7%), with a score of 4 (60%); these patients also most often required revascularization (46.7%). The threshold values of the end point predictors were established: SE score > 1.5 (p < 0.001); LV peak GLS < 16.55% (p = 0.016); SR < 1.7 (p = 0.033); chronotropic reserve < 1.79 (p = 0.010). In multivariate analysis, outcome predictors were the nature of chest pain (OR 5.1; p = 0.007), LVEF at peak load (OR 0.82; p = 0.012), SR value (OR 16.0; p = 0.007) and the sum of SE points (OR 18.0; p = 0.006).

Conclusion. In non-invasive diagnostics of significant coronary lesions and prediction of the nearest adverse cardiovascular events in patients with known and suspected coronary artery disease, along with the traditional criterion — the appearance of zones of local LV contractility and the associated decrease in LVEF, LV GLS, and an increase in INLS, additional informative criteria were identified among the parameters of the five-stage SE.

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