Accuracy and Prognostic Value of Physiologist-Led Stress Echocardiography for Coronary Disease
| Autor: | Arron Pasricha, Tamseel Fatima, Vetton Chee Kay Lee, Sinead Cabezon, Samantha Booth, Shanat Baig, Robert Butler, Andreea Mihai, Kam Rai, Chun Shing Kwok, Timothy Griffiths, Emily Robins, Tamara Naneishvili, Sadie Bennett, Kully Sandhu, Grant Heatlie, Simon Duckett, Prathap Kanagala, Doug Lee, Jamal Nasir Khan |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Coronary Artery Disease 030204 cardiovascular system & hematology Coronary disease Coronary Angiography Coronary artery disease 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Stress Echocardiography Humans 030212 general & internal medicine Retrospective Studies business.industry Incidence (epidemiology) Retrospective cohort study Gold standard (test) Prognosis medicine.disease Exercise Test Cardiology Dobutamine Cardiology and Cardiovascular Medicine business Mace Echocardiography Stress medicine.drug |
| Zdroj: | Heart, Lung and Circulation. 30:721-729 |
| ISSN: | 1443-9506 |
| DOI: | 10.1016/j.hlc.2020.09.933 |
| Popis: | Background We demonstrated that physiologist-led stress echocardiography (PLSE) is feasible for coronary artery disease (CAD) assessment. We sought to extend our work by assessing its accuracy and prognostic value. Methods Retrospective study of 898 subjects undergoing PLSE (n=393) or cardiologist-led stress echocardiography (CLSE) (n=505) for CAD assessment using exercise or dobutamine. For accuracy assessment, the primary outcome was the ability of stress echocardiography to identify significant CAD on invasive coronary angiography (ICA). Incidence of 24-month non-fatal MI, total and cardiac mortality, revascularisation and combined major adverse cardiac events (MACE) were assessed. Results Demographics, comorbidities, CAD predictors, CAD pre-test probability and cardiac medications were matched between the PLSE and CLSE groups. PLSE had high sensitivity, specificity, positive and negative predictive value and accuracy (85%, 74%, 69%, 88%, 78% respectively). PLSE accuracy measures were similar and non-inferior to CLSE. There was a similar incidence of individual and combined outcomes in PLSE and CLSE subjects. Negative stress echocardiography conferred a comparably low incidence of non-fatal MI (PLSE 1.4% vs. CLSE 0.9%, p=0.464), cardiac mortality (0.6% vs. 0.0%, p=0.277) and MACE (6.8% vs. 3.1%, p=0.404). Conclusion This is the first study of the accuracy compared with gold standard of ICA, and prognostic value of PLSE CAD assessment. PLSE demonstrates high and non-inferior accuracy compared with CLSE for CAD assessment. Negative PLSE and CLSE confer a similarly very low incidence of cardiac outcomes, confirming for the first time the important prognostic value of PLSE. |
| Databáze: | OpenAIRE |
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