Author + information
- Vadim A. Kuznetsov,
- Dmitriy Krinochkin,
- Elena Yaroslavskaya,
- Georgiy Pushkarev and
- Elena Zakharova
Background: Conventional isometric stress echocardiography is not routinely used in the assessment of coronary artery disease (CAD) because of low sensitivity in diagnosis of coronary lesions. The purpose of this study was to determine diagnostic value of new modification of isometric handgrip stress echocardiography for detection of CAD – maximal isometric handgrip/emotional stress echocardiography (MISE) in patients with suspected CAD compared with conventional dobutamine stress echocardiography (DSE).
Methods: 197 patients with suspected CAD were studied before coronary angiography: 87 of them underwent MISE, 110 – conventional DSE. After baseline measurements by echocardiography at rest, MISE patients undertook a handgrip-maneuver with the balloons. The echocardiographic image was monitored throughout the maneuver. The squeezing of the balloons was performed with the both hands and sustained at maximal voluntary contraction for 3 min. The emotional component of stress was performed: the investigator inspired patient to maximal effort during the stress. DSE was performed using standard protocol. Quantitative coronary angiography served as a reference standard for anatomic disease (significant CAD defined as ≥50% reference diameter).
Results: CAD patients revealed by MISE and DSE did not differ in rate of multiple coronary stenoses: 40.4% and 45.5% (p=NS). MISE gave virtually equal sensitivity, 84.5% (95% CL=74.1-94.8) compared to DSE, 87.3% (95% CI=78.3-96.3) in obtained data (p=NS) and specificity – 85.7% (95% CI=71.4-99.7) and 76.6% (95% CI=62.5-90.7), respectively (p=NS). The positive predictive value of two tests was almost similar, 92.5% (95% CI=84.9-99.8) for MISE and 83.3% (95% CI=73.3-93.4) for DSE, as well as the negative predictive value: for MISE 72.7% (95% CI=54.5-90.9) and 81.8% (95% CI=69.0-94.7) for DSE (both p=NS). Overall accuracy for MISE did not differ from DSE – 84.9% (95% CI=76.5-93.3) and 82.7% (95% CI=74.8-90.7), p=NS.
Conclusions: MISE and DSE have a similar diagnostic value in detection of significant coronary lesions in suspected CAD patients. However, MISE is easier to carry out, this method is less time consuming and less expensive compared to DSE.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-350
- 2017 American College of Cardiology Foundation