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Improving stress echocardiography accuracy for detecting left circumflex artery stenosis: A new echocardiographic sign?
MedLine Citation:
PMID:  22633293     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: The accuracy and reproducibility of stress echocardiography (SE) for the detection of coronary artery lesions requires improvement, particularly in the left circumflex artery (LCx).
AIMS: To evaluate the feasibility and diagnostic value of a new sign: Rise of the Apical lateral wall and/or Horizontal displacement of the Apex toward the septum ("RA-HA") in apical echocardiographic views.
METHODS: Consecutive patients with normal left ventricular function at rest, positive SE and an indication for coronary angiography were included. SEs were analysed blindly by three independent cardiologists: two seniors (S1 and S2) and one junior (J).
RESULTS: Of 81 patients, 58 had an exercise SE and 23 had a dobutamine SE. Significant coronary stenosis was found in 59 of 77 patients who underwent coronary angiography (76.6%). Interobserver reproducibility for the presence of RA-HA was very good between S1 and S2 (κ=0.86), and good between S1 and J (0.67) and S2 and J (0.70). The sensitivity, specificity and positive and negative predictive values of RA-HA for the detection of significant coronary artery stenosis were, respectively, 39-41%, 83-89%, 88-92% and 29-31% for S1/S2; and 29%, 83%, 85% and 26% for J. To predict LCx stenosis (single or multivessel): 67-70%, 89%, 80-81% and 80-82% for S1/S2, respectively, and 50%, 89%, 75% and 74% for J.
CONCLUSION: With a short learning curve, RA-HA is easily diagnosed with a very good interobserver reproducibility. It has high specificity and PPV for the detection of a coronary artery stenosis, particularly in the LCx artery, during exercise or dobutamine SE.
Authors:
Christophe Chauvel; Eric Abergel; Lionel Renault; Gilles Chatellier; Iris Cohen; Claire Attane; Marc Simon; Emmanuel Bogino; Patrick Dehant
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Publication Detail:
Type:  Journal Article     Date:  2012-04-17
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  105     ISSN:  1875-2128     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-05-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  196-202     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Affiliation:
Laboratoire d'échographie cardiaque, clinique Saint-Augustin, 114, avenue d'Ares, 33000 Bordeaux, France.
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