Predictors of Coronary Artery Disease in Patients With
ST
‐T Segment Alterations Undergoing Elective Coronary Angiography: The Role of Global Longitudinal Strain
In patients with ST‐T changes, LVGLS, male sex, and typical chest pain independently predict the presence of CAD, while LVGLS is also strongly associated with disease severity.
Abstract
Electrocardiography (ECG) is recommended as first investigation for chronic coronary artery disease (CAD), often showing ST segment depression and/or T‐wave changes, which are nonspecific. We aimed to identify predictors of CAD presence and severity in patients with ST‐T changes undergoing elective coronary angiography (ECA).
In this prospective cross‐sectional study, 84 consecutive patients with ST‐T changes on ECG undergoing ECA were evaluated using clinical, electrocardiographic, conventional echocardiography, and speckle tracking parameters. Multivariable logistic and linear regression analyses were performed to identify independent factors associated with CAD presence and severity.
Of the 84 patients, 36 (42.9%) had significant CAD. The number of affected vessels was significantly associated with age, male sex, smoking, typical chest pain, WMSI, and LVGLS (all
p
≤ 0.01). In multivariable logistic regression, male sex (OR 2.89, 95% CI 1.36–6.11,
p
= 0.006), typical chest pain (OR 2.26, 95% CI 1.05–4.87,
p
= 0.04), and LVGLS (OR 2.11, 95% CI 1.41–3.13,
p
< 0.001) were independently associated with CAD. In multivariable linear regression, LVGLS (std
β
= 0.32,
p
= 0.001), sex (std
β
= 0.29,
p
< 0.001), smoking (std
β
= 0.22,
p
= 0.003), and WMSI (std
β
= 0.20,
p
= 0.039) were independently associated with the number of affected coronary vessels. LVGLS demonstrated excellent diagnostic performance (AUC = 0.89, 95% CI 0.82–0.97,
p
< 0.001).
In patients with ST‐T changes, LVGLS, male sex, and typical chest pain independently predict the presence of CAD, while LVGLS is also strongly associated with disease severity. LVGLS shows excellent discriminatory ability and may improve noninvasive risk stratification in this population.
Routinely available ECG-derived P-wave dispersion and echocardiographic LAVI are independent, complementary predictors of MACE in CAD patients, and integrating these two parameters into a simple risk model significantly enhances risk discrimination and reclassification, providing a practical, cost-effective tool for individualized management.
Qin Wu, Gang Chen, Jian Chang· Frontiers in Medicine· 0 citations
BACKGROUND
Left main coronary artery (LMCA) disease carries high morbidity and mortality and requires early identification. Although ST-segment elevation in lead aVR has been associated with severe coronary artery disease, its diagnostic value relative to lead V1 remains unclear.
METHODS
This cross-sectional study included 180 patients with acute coronary syndrome undergoing coronary angiography. Patients were stratified according to ST-segment elevation in lead aVR greater than V1 versus ≤ V1. Significant LMCA stenosis was defined as ≥50% luminal narrowing. Diagnostic performance was evaluated using validity measures, receiver operating characteristic (ROC) analysis, and multivariable logistic regression.
RESULTS
Significant LMCA involvement was more frequent in patients with aVR elevation exceeding V1 (91.1% vs. 20.0%, p < 0.001). The ECG criterion showed 82.0% sensitivity, 90.0% specificity, 85.6% accuracy, 91.1% positive predictive value, and 80.0% negative predictive value. ROC analysis demonstrated good discrimination (AUC 0.86; 95% CI 0.806-0.914). After adjustment for clinical confounders, aVR elevation greater than V1 remained independently associated with LMCA disease (adjusted OR 41.0; 95% CI 16.0-100.0; p < 0.001).
CONCLUSIONS
ST-segment elevation in lead aVR exceeding that in lead V1 was independently associated with LMCA disease in patients with acute coronary syndrome and provided effective diagnostic stratification in this cohort. This simple ECG finding may assist early risk stratification and prompt consideration of urgent invasive evaluation, although external validation in larger prospective studies is warranted.
O. Kuru, Deniz Seleci· Acta Cardiologica· 1 citation· ⚡1
AIM
To investigate the relationship between coronary artery calcium (CAC) score and left ventricular global longitudinal strain (LV GLS) in patients with arterial hypertension who had a negative treadmill exercise stress test but mild to intermediate coronary stenosis on coronary computed tomography angiography (CCTA).
METHODS
A total of 53 hypertensive patients (mean age 54.8 ± 4.8 years; 50.9% male) with 30-50% coronary stenosis on CCTA were included. Patients with diabetes, malignancy, or established coronary/peripheral artery disease were excluded. CAC score, left ventricular ejection fraction (LVEF, Simpson's method), and LV GLS (speckle-tracking echocardiography) were measured. Groups were stratified by GLS (< 18.5% vs. ≥ 18.5%) and LVEF (< 60% vs. ≥ 60%), and CAC score differences were assessed using the Mann-Whitney U test.
RESULTS
The median CAC score was 27 (IQR 16-44.5), median LVEF 60% (IQR 58-63%), and mean GLS 19.37 ± 0.89%. No overall association was found between CAC score and LV function by LVEF or GLS. In patients with left anterior descending (LAD) stenosis (30-50%), reduced LV function was linked to significantly higher CAC score. Median CAC score was higher in patients with GLS ≤ 18.5% (157 vs. 44.5; p = 0.019) and LVEF <60% (157 vs. 44.5; p = 0.019). No significant associations were found in right coronary artery (RCA), circumflex artery (Cx), or three-vessel stenosis subgroups.
CONCLUSION
Higher CAC score in hypertensive patients with mild LAD stenosis and negative stress testing identify those at risk of subclinical LV dysfunction.
E. Begić, Ada Djozic, N. Mlaco-vrazalic et al.· Medicinski glasnik· 0 citations
Resumo Fundamento: O valor prognóstico da mensuração do escore de cálcio das artérias coronárias (CAC) na doença arterial coronária (DAC) não obstrutiva (definida como estenose < 50%) não está suficientemente descrito. Objetivos: Investigar a associação entre a mensuração do CAC, fatores de risco cardiovascular e desfechos clínicos em pacientes com DAC não obstrutiva. Métodos: Ao todo, 2.509 pacientes foram submetidos à angiotomografia coronariana (angioTC) e acompanhados por 8,9 ± 2,6 anos. Conforme o CAD-RADS™ 2.0, a carga de placa foi classificada em ausente, leve, moderada e alta/muito alta. O desfecho primário foi um composto de mortalidade por todas as causas, síndrome coronariana aguda/infarto agudo do miocárdio e acidente vascular encefálico. A significância estatística foi estabelecida em 5%. Resultados: O escore de CAC foi 0 em 45,4% dos pacientes, 1-99 em 36,6% e ≥ 100 em 18,0%. Correspondentemente, 38,3% dos pacientes não apresentavam lesões coronarianas, 38,5% apresentavam lesões leves, 14,1% lesões moderadas e 9,2% lesões altas/muito altas. Entre os pacientes com CAC = 0, a ausência de lesões coronarianas predominou (81,2%), enquanto foi rara entre aqueles com CAC ≥ 100. O desfecho primário ocorreu em 4,9% dos pacientes, predominantemente impulsionado pela mortalidade por todas as causas. Entre os 396 pacientes com angioTC coronariana seriada (intervalo médio: 6,5 ± 2,6 anos), a progressão do CAC (> 2,5 de aumento com base no método da raiz quadrada) foi observada em 41,9%. A carga de placa aumentou em paralelo. O escore de CAC apresentou associação positiva com a carga de placa e com fatores de risco cardiovascular. Conclusões: Na DAC não obstrutiva, o CAC está presente em mais da metade dos pacientes e está associado tanto à carga de placa quanto aos fatores de risco cardiovascular. A incidência do desfecho primário aumenta proporcionalmente à carga de fatores de risco e aos níveis de CAC. O CAC e a carga de placa progridem concomitantemente ao longo do tempo, sustentando o papel do CAC como marcador substituto da progressão da aterosclerose subclínica.
P. D. da Luz, Desidério Favarato, Alexandre A. C. Abizaid et al.· Arquivos Brasileiros de Card...· 1 citation
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