title: Predicting clinically unrecognized coronary artery disease: use of two- dimensional echocardiography.
abstract: BACKGROUND
  2-D Echo is often performed in patients without history of coronary artery disease (CAD). We sought to determine echo features predictive of CAD.
  
  
  METHODS
  2-D Echo of 328 patients without known CAD performed within one year prior to stress myocardial SPECT and angiography were reviewed. Echo features examined were left ventricular and atrial enlargement, LV hypertrophy, wall motion abnormality (WMA), LV ejection fraction (EF) < 50%, mitral annular calcification (MAC) and aortic sclerosis/stenosis (AS). High risk myocardial perfusion abnormality (MPA) was defined as >15% LV perfusion defect or multivessel distribution. Severe coronary artery stenosis (CAS) was defined as left main, 3 VD or 2VD involving proximal LAD.
  
  
  RESULTS
  The mean age was 62 +/- 13 years, 59% men, 29% diabetic (DM) and 148 (45%) had > 2 risk factors. Pharmacologic stress was performed in 109 patients (33%). MPA was present in 200 pts (60%) of which, 137 were high risk. CAS was present in 166 pts (51%), 75 were severe. Of 87 patients with WMA, 83% had MPA and 78% had CAS. Multivariate analysis identified age >65, male, inability to exercise, DM, WMA, MAC and AS as independent predictors of MPA and CAS. Independent predictors of high risk MPA and severe CAS were age, DM, inability to exercise and WMA. 2-D echo findings offered incremental value over clinical information in predicting CAD by angiography. (Chi square: 360 vs. 320 p = 0.02).
  
  
  CONCLUSIONS
  2-D Echo was valuable in predicting presence of physiological and anatomical CAD in addition to clinical information.
authors.affiliation: Department of Cardiology, DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX, USA. schang@tmhs.org
authors.forename: Su Min
authors.initials: SM
authors.lastname: Chang
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Nagueh
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003326:Coronary Circulation; D016208:Databases, Factual; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon