Department of Cardiology, IRCCS, Milan.
Department of Cardiology, Policlinico San Giorgio, Pordenone, Italy.
J Cardiovasc Med (Hagerstown). 2022 Aug 1;23(8):524-534. doi: 10.2459/JCM.0000000000001344.
The influence of chest wall shape on exercise stress echocardiography (ESE) results has been poorly investigated. We aimed at evaluating the main predictors of true positive (TP)-ESE in a population of subjects with suspected coronary artery disease (CAD), categorized according to chest wall conformation, assessed by modified Haller index (MHI, chest transverse diameter over the distance between sternum and spine).
All consecutive patients with suspected CAD referred to our EchoLab for performing ESE between September 2011 and October 2021 were retrospectively enrolled. Preliminary assessment of both pretest probability (PTP) and MHI was performed. All patients with positive ESE underwent coronary angiography. Obstructive CAD was diagnosed by ≥70% stenosis in any epicardial coronary artery. Outcome was TP ESE result.
One thousand two hundred and seventy-five consecutive patients (64.9 ± 13.0 years) entered the study. Subjects with concave-shaped chest wall (MHI > 2.5) (10.7%) and those with normal chest shape (MHI ≤ 2.5) (89.3%) were separately analyzed. PTP was similar in both groups (21.8 ± 13.2 vs. 23.5 ± 13.3%, P = 0.15). One hundred and seventy patients were diagnosed with positive ESE: 129 (75.9%) had obstructive CAD (TP), whereas the remaining 41 (24.1%) had no CAD. Only 2.3% of TP ESE was detected in subjects with MHI >2.5. PTP [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.04], dyslipidemia (OR 4.37, 95% CI 2.81-6.80), dyssynergy in the left anterior descending territory (OR 8.21, 95% CI 5.07-13.3) were linearly correlated with TP ESE, whereas MHI >2.5 (OR 0.25, 95% CI 0.14-0.67) was inversely associated with outcome.
Subjects with MHI >2.5 have low prevalence of TP ESE, regardless of PTP. Preliminary MHI assessment may reduce overestimation of PTP of CAD.
胸壁形状对运动负荷超声心动图（ESE）结果的影响尚未得到充分研究。我们旨在评估疑似冠心病（CAD）患者中根据改良 Haller 指数（MHI，胸骨和脊柱之间的距离上的胸横径）分类的胸壁形态的主要预测因素。
回顾性纳入 2011 年 9 月至 2021 年 10 月间因疑似 CAD 到我们的超声心动图实验室进行 ESE 的所有连续患者。初步评估了术前概率（PTP）和 MHI。所有 ESE 阳性的患者均接受冠状动脉造影。通过任何心外膜冠状动脉的 ≥70%狭窄诊断为阻塞性 CAD。结果为真阳性（TP）ESE 结果。
1275 例连续患者（64.9±13.0 岁）入组。胸壁凹形（MHI＞2.5）的患者（10.7%）和胸壁正常形状（MHI≤2.5）的患者（89.3%）分别进行分析。两组的 PTP 相似（21.8±13.2 与 23.5±13.3%，P=0.15）。170 例患者被诊断为 ESE 阳性：129 例（75.9%）有阻塞性 CAD（TP），而其余 41 例（24.1%）无 CAD。MHI＞2.5 的患者中仅检测到 2.3%的 TP ESE。PTP[比值比（OR）1.03，95%置信区间（CI）1.01-1.04]、血脂异常（OR 4.37，95%CI 2.81-6.80）、左前降支区域的不协调运动（OR 8.21，95%CI 5.07-13.3）与 TP ESE 呈线性相关，而 MHI＞2.5（OR 0.25，95%CI 0.14-0.67）与结果呈负相关。
无论 PTP 如何，MHI＞2.5 的患者 TP ESE 的发生率较低。初步 MHI 评估可能会降低 CAD 的 PTP 过高估计。
