Improving stress echocardiography accuracy for detecting left circumflex artery stenosis: a new echocardiographic sign?
BACKGROUND
The accuracy and reproducibility of stress echocardiography (SE) for the detection of coronary artery lesions requires improvement, particularly in the left circumflex artery (LCx).


OBJECTIVE
To evaluate the feasibility and diagnostic value of a new sign: Rise of the Apical lateral wall and/or Horizontal displacement of the Apex toward the septum ("RA-HA") in apical echocardiographic views.


METHODS
Consecutive patients with normal left ventricular function at rest, positive SE and an indication for coronary angiography were included. SEs were analysed blindly by three independent cardiologists: two seniors (S1 and S2) and one junior (J).


RESULTS
Of 81 patients, 58 had an exercise SE and 23 had a dobutamine SE. Significant coronary stenosis was found in 59 of 77 patients who underwent coronary angiography (76.6%). Interobserver reproducibility for the presence of RA-HA was very good between S1 and S2 (κ = 0.86), and good between S1 and J (0.67) and S2 and J (0.70). The sensitivity, specificity and positive and negative predictive values of RA-HA for the detection of significant coronary artery stenosis were, respectively, 39-41%, 83-89%, 88-92% and 29-31% for S1/S2; and 29%, 83%, 85% and 26% for J. To predict LCx stenosis (single or multivessel): 67-70%, 89%, 80-81% and 80-82% for S1/S2, respectively, and 50%, 89%, 75% and 74% for J.


CONCLUSIONS
With a short learning curve, RA-HA is easily diagnosed with a very good interobserver reproducibility. It has high specificity and PPV for the detection of a coronary artery stenosis, particularly in the LCx artery, during exercise or dobutamine SE.
Laboratoire d'échographie cardiaque, clinique Saint-Augustin, 114, avenue d'Ares, 33000 Bordeaux, France.
Christophe
C
Chauvel
Eric
E
Abergel
Lionel
L
Renault
Gilles
G
Chatellier
Iris
I
Cohen
Claire
C
Attane
Marc
M
Simon
Emmanuel
E
Bogino
Patrick
P
Dehant
D000368:Aged; D002316:Cardiotonic Agents; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004280:Dobutamine; D025401:Echocardiography, Stress; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005602:France; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left
D002316:Cardiotonic Agents; D004280:Dobutamine