Effectiveness of resting transthoracic echocardiography at detecting significant coronary artery disease in adults

Abstract

Structured AbstractBackground:Detection of regional wall motion abnormalities (RWMA) on TTE is a commonly used to correlate for coronary artery disease (CAD) and often prompts a further workup, including cardiac computed tomography (CT) or cardiac catheterization. However, RWMAs do not consistently predict obstructive CAD. This study investigates the accuracy and reliability of the presence of RWMA on TTE at detecting significant CAD (≥ 70 % vessel stenosis).Methods:A retrospective chart review was conducted of adults seen by the Baylor Scott & White Temple echocardiography laboratory who received a resting TTE followed by cardiac catheterization within 30 days over a 4-year period. Exclusion criteria included catheterization without coronary angiography and prior history of CAD, percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). We analyzed RWMA on TTE and atherosclerotic CAD on cardiac catheterization to assess for correlation.Results:435 patients were included in the study and 198 patients received ultrasound enhancing agent (UEA). The sensitivity and specificity of RWMA on TTE for detecting CAD in adults was 49.5 % and 78.8%, respectively. The positive and negative likelihood ratios were 2.33 and 0.641, respectively. The use of UEA made no significant difference in the sensitivity or specificity.Discussion:Our results show that the presence of RWMA on TTE has a high ability to rule in CAD but the absence of RWMA displays a much lower ability to rule out CAD than previously reported. Our results also show UEA did not enhance or detract this relationship. Clinicians should be aware that the presence of RWMA on resting TTE has a high association with obstructive CAD but the absence of RWMA does not sufficiently exclude CAD.Clinical PerspectiveCurrent guidelines support the use of resting TTE in suspected occlusive coronary artery disease when ECG, biomarkers, and patient history are insufficient to warrant cardiac catheterization. Our study demonstrated the presence of RWMA on resting TTE has a high association with obstructive CAD but the absence of RWMA does not sufficiently exclude CAD. While a positive TTE provides good evidence for additional workup of CAD, practicing clinicians should carefully weigh their plan in the event of a negative TTE prior to ordering the test to determine if the test is a necessary diagnostic step for their patient. If the clinician would decide to continue with a workup for CAD despite a negative resting TTE, the clinician may consider skipping the TTE and moving straight to their further workup to increase the economic value of care provided.