(VP104) STRESS ECHOCARDIOGRAPHY PREDICTORS OF MULTI-VESSEL OBSTRUCTIVE CORONARY ARTERY DISEASE IN A HIGH-RISK POPULATION

Background: Stress echocardiography (SE) is an established imaging technique for diagnosis and risk stratification of patients with suspected or known coronary artery disease (CAD). The recently upgraded ABCDE protocol is of high accuracy in predicting multivessel obstructive CAD and survival in patients with chronic coronary syndromes. However, it is not widely performed and has not become standard of practice. The aim of this study is to evaluate the ability of combined conventional SE parameters in detecting multivessel obstructive CAD.

METHODS AND RESULTS: A total of 330 consecutive patients with a stress echocardiography were identified between January 2018 and April 2022. Ejection fraction (EF), end-systolic volume (ESV), wall motion score index (WMSI) and global longitudinal strain (GLS) were calculated at rest and peak stress. SE was considered abnormal if there were any of the following: new chest pain or equivalent, new ischemic ECG changes, worsening EF or GLS, higher ESV, or new WMAs at peak stress. All patients had subsequent ICA as a reference test to match for any CAD within 6 months of the non-invasive evaluation. Multi-vessel obstructive CAD was defined if at least 2 epicardial vessels were involved with significant stenosis on anatomic or physiologic evaluation.

Mean age was 66 ± 9 years with 234 (70.9%) male and 114 (34.5%) diabetics. There were 209 (63.3%) patients who had obstructive CAD on ICA; 80 (24.2%) with single vessel, 110 (33.3%) with ≥ 2 vessels. Patients with multi-vessel obstructive CAD had lower GLS at peak stress compared to those with single or no vessel disease (13% IQR 10-16 vs 15% IQR 12-18 respectively, P=0.003). They also had a higher median WMSI at peak stress (1.47 IQR 1.17-1.82 vs 1.23 IQR 1.00-1.47 respectively, P< 0.001). A cut-off peak stress value of GLS < 15% was associated with increased risk of multi-vessel CAD (OR 1.9, 95% CI 1.4-3.0, P=0.014), as did an increase of WMSI by at least 0.2 (OR 2.4, 95% CI 1.5-3.9, P< 0.001). When combining clinical, electrical, and echocardiographic parameters, the negative predictive value (NPV) of SE to exclude multi-vessel obstructive CAD was 84%, with a sensitivity of 91%.

Conclusion: Our analysis suggests that combining conventional stress imaging parameters may be useful to rule out multivessel disease, despite recent advances in stress echocardiography protocols.