Background
Methods
Study Population
TTE Data
Gated Stress Myocardial Perfusion Imaging
Coronary Angiography
Statistical Analysis
Results
Baseline Characteristics
Mean Age (years) | 62 ± 14 |
Age > 65 years | 156 (48%) |
Male gender | 193 (59%) |
Chest Pain as indication for SPECT | 180 (55%) |
DM | 95 (29%) |
Hypertesion | 178 (55%) |
Hyperlipidemia | 77 (24%) |
History of smoking | 98 (30%) |
Family history of CAD | 98 (30%) |
Number of Risk Factors | 1.7 ± 1 |
Abnormal Rest ECG | 245 (74%) |
Unable to Exercise | 109 (33%) |
2-D Echo Features
| |
LVE | 71 (22%) |
LVH | 170 (52%) |
LVEF < 50% | 69 (21%) |
WMA | 87 (27%) |
LAE | 174 (53%) |
MAC | 142 (43%) |
AS | 155 (47%) |
SPECT | ||
---|---|---|
Normal MPI | 127 | 39% |
Abnormal MPI | 201 | 61% |
High Risk Scan | 137 | 42% |
Predominant ischemic Defect | 156 | 48% |
Predominant Fixed Defect | 45 | 13% |
Perfusion Defect Size (% Left Ventricle) | 19 ± 12 | |
ANGIOGRAPHY
| ||
No significant CAS | 163 | 49% |
One vessel Disease | 55 | 17% |
Two vessels Disease without involving proximal LAD | 35 | 11% |
Two vessels Disease involving proximal LAD | 19 | 6% |
Three vessels or left main Disease | 56 | 17% |
2-D echo predictors of CAD (Table 3)
Abnormal MPI | P = | CAS | P = | ||||
---|---|---|---|---|---|---|---|
LVE
|
yes
| 53/71 | 75% |
0.013
| 39/71 | 55% | 0.49 |
no
| 148/257 | 57% | 126/257 | 49% | |||
LVH
|
yes
| 90/170 | 53% |
0.002
| 79/170 | 47% | 0.18 |
no
| 111/158 | 70% | 86/158 | 54% | |||
LVEF
|
<50%
| 58/69 | 84% |
<0.001
| 45/69 | 65% |
0.01
|
> = 50%
| 143/259 | 55% | 120/259 | 46% | |||
WMA
|
yes
| 73/87 | 83% |
<0.001
| 56/87 | 65% |
0.004
|
no
| 138/241 | 53% | 109/241 | 45% | |||
LAE
|
yes
| 101/174 | 58% | 0.24 | 74/174 | 42% | 0.17 |
no
| 100/154 | 64% | 78/154 | 50% | |||
MAC
|
yes
| 110/142 | 77% |
<0.001
| 87/142 | 62% |
<0.001
|
no
| 108/186 | 58% | 77/186 | 42% | |||
AS
|
yes
| 105/155 | 68% |
0.003
| 99/155 | 64% |
<0.001
|
no
| 96/173 | 55% | 66/173 | 38% |
Independent predictors of CAD
Odds Ratio | 95% Confidence Intervals | P- value | ||
---|---|---|---|---|
CAS
| age> 65 | 2.9 | 1.7–4.9 | 0.002 |
Male | 2.2 | 1.3–3.7 | 0.02 | |
Inability to exercise | 2.9 | 1.5–5.5 | <0.001 | |
DM | 4.1 | 2.2–7.9 | <0.001 | |
WMA | 3 | 1.3–7.1 | 0.007 | |
MAC | 2.2 | 1.2–3.7 | 0.03 | |
AS | 2.3 | 1.3–3.9 | 0.03 | |
MPA
| age> 65 | 1.4 | 1–2.5 | 0.05 |
Male | 2.7 | 1.7–4.8 | <0.001 | |
Inability to exercise | 3.1 | 1.8–5.3 | <0.001 | |
DM | 2.1 | 1.1–4 | 0.02 | |
WMA | 2.2 | 1.1–6 | 0.04 | |
MAC | 2 | 1.1–3.5 | 0.03 |
Odds Ratio | 95% Confidence Intervals | P | ||
---|---|---|---|---|
Severe CAS
| age> 65 | 3.76 | 1.97–7.17 | <0.001 |
Inability to exercise | 2.9 | 1.01–5.5 | 0.04 | |
DM | 4.5 | 2.2–5.7 | 0.001 | |
WMA | 2.4 | 1.02–5.7 | 0.04 | |
High Risk MPA
| age> 65 | 2.2 | 1.3–3.7 | 0.003 |
Inability to exercise | 1.7 | 1.0–2.8 | 0.05 | |
DM | 2.8 | 1.5–5.0 | 0.001 | |
WMA | 2.26 | 1.05–4.9 | 0.02 | |
MAC | 1.9 | 1.08–3.3 | 0.01 |