Sino-tubular junction to sinuses of Valsalva ratio: An echocardiographic parameter to predict coronary artery ectasia in patients with aortic enlargement. (1st December 2021)

• Record Type: Journal Article
• Authors: Ghetti, Gabriele; Minnucci, Matteo; Chietera, Francesco; Donati, Francesco; Gagliardi, Christian; Bruno, Antonio Giulio; Orzalkiewicz, Mateusz; Nardi, Elena; Palmerini, Tullio; Saia, Francesco; Marrozzini, Cinzia; Galié, Nazzareno; Taglieri, Nevio
• Is Part Of: International journal of cardiology. Volume 344(2021)
• Page Start: 226
• Page End: 229
• Publication Date: 2021-12-01
• Subjects: Coronary artery ectasia -- Ascending aortic aneurysm -- Sino-tubular junction ectasia -- Sino-tubular junction to sinuses of Valsalva ratio; CAE coronary artery ectasia -- EP echocardiographic parameters -- STJ-to-SV sino-tubular junction diameter to sinuses of Valsalva diameter ratio -- STJ-to-AA sino-tubular junction diameter to ascending aorta diameter ratio -- SV sinuses of Valsalva diameter -- STJ sino-tubular junction diameter -- AA ascending aorta -- BMI body mass index -- ROC Receiver-operating characteristic -- AUC area under the ROC curve -- OR odds ratio; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.10.009
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Coronary artery ectasia (CAE) is associated with ascending aortic (AA) ectasia. The purpose of this study is to evaluate the diagnostic performance of different echocardiographic parameters (EP) in predicting the presence of CAE. Methods: Four hundred-eighteen patients with AA ectasia candidate to coronary angiography were identified and divided in two groups in respect of the presence of CAE. Receiver-operating characteristic curves areas (AUC) were used to assess the discrimination power of the following EP: aortic annulus diameter, sinuses of Valsalva (SV) diameter, sino-tubular junction (STJ) diameter, AA diameter, STJ to SV ratio (STJ-to-SV) and STJ to AA ratio (STJ-to-AA). All these parameters were indexed by body surface area. The relationship between the best EP and the presence of CAE was investigated by means of multivariable logistic regression. Results: The rate of CAE in the study population was 32%. On univariable logistic regression, aortic annulus, STJ, STJ-to-SV and STJ-to-AA were associated with the presence of CAE after Bonferroni correction. STJ-to-SV emerged as the parameter with the best discrimination power (AUC = 0.81) compared to STJ (AUC = 0.69), STJ-to-AA (AUC = 0.68), aortic annulus (AUC = 0.59), AA (AUC = 0.56) and SV (AUC = 0.55); (p for comparison <0.01). An 89.6% value for STJ-to-SV ratio emerged as the best cut-off to diagnose CAE with a sensitivity = 75%, specificity = 82%, positive predictive value = 66% and negative predictive value = 88%. On multivariable analysis, STJ-to-SV was still associated with the presence of CAE (OR = 1.15;95%CI:1.11–1.19; p < 0.01). Conclusion: In patients with dilated aorta, STJ-to-SV sampled by transthoracic echocardiography shows a good diagnostic performance in predicting the presence of CAE. Graphical abstract: Non invasive predictor of coronary artery ectasia: sino-tubular junction diameter to sinus of Valsava diameter ratio at transthoracic echocardiography is a good tool to prognosticate the presence of coronary artery ectasia at coronary angiography in patients with ascending aorta dilatation. Unlabelled Image Highlights: Coronary ectasia (CAE) is linked to ascending aortic aneurysms, but not all of them are affected by CAE. Coronary angiography is the gold standard for CAE diagnosis. Echo assessment was done in all patients candidate to coronary angiography with ascending aorta ≥4 mm. Angiography presence of CAE let us to compare the two groups. The sino-tubular junction to sinus of Valsalva ratio is the best echo predictor of CAE.