The importance and predictive value of supplementary diagnostic methods in identifying coronary heart disease in patients with a low pre-test probability
Abstract
Background
Coronary heart disease (CHD) is the leading cause of mortality among diseases of the circulatory system. Early identification of CHD facilitates timely diagnosis and reduces mortality. The initial assessment during a physician's visit is the pretest probability (PTP) of CHD, which lacks high sensitivity and specificity. Therefore, determining the prognostic value of additional, clarifying examination methods is important.
Aim
To evaluate the diagnostic sensitivity and specificity of the Agatston score and left ventricular Global Longitudinal Strain average (GLSavg) for identifying hemodynamically significant coronary artery stenosis in patients with PTP of CHD between 5% and 15%.
Methods
A cross-sectional cohort study of patients (n=95) of both sexes (more than 57% to men and more than 42% to women) aged 45–65 years, meeting inclusion criteria (signed informed consent for participation in the study and a PTP value of 5–15%) was conducted in 2024–2025.
Results
The main comorbidities were arterial hypertension and/or dyslipidemia. The Agatston score was 344 [95; 652] units, GLSavg was -18 [-20;-15]%. Hemodynamically significant coronary artery stenosis was detected in 50.5% of cases. The cut-off point for the Agatston score was 120 units; diagnostic sensitivity: 96.55%, specificity: 55.56%; area under the ROC curve: 0.746±0.072 (95% confidence interval 0.612–0.853, z=3.421, p=0.0061). The cut-off point for GLSavg was -18%; diagnostic sensitivity: 93.10%, specificity: 77.78%; area under the ROC curve: 0.945±0.026 (95% confidence interval 0.849–0.988, z=16.769, p=0.00012).
Conclusion
Based on the study results, the cut-off values for the Agatston score and GLSavg, as well as their sensitivity and specificity, were determined. Despite certain limitations of the study (sample size), these values allow for clarifying the indications for coronary angiography.