A single-center prospective study: assessment of coronary arteries during routine echocardiography; feasibility and prognostic value. (14th October 2021) - Zagatina, A
Abstract: Background: Previous pilot studies have shown a significant diagnostic value of coronary artery (CA) velocity parameter assessment acquired during echocardiography examinations [1]. The main limitations for the assessment of CA are considered low feasibilities and unknown cut-off values for patients' prognosis. Aims of the study were the evaluation of the feasibility of left-sided coronary artery assessment during echocardiography and its prognostic value analysis in non-selected patients' population. Methods: This is a single-center prospective study. All consecutive patients who were referred to echocardiography were included in the study by having additional scans of left-sided CA. One thousand four hundred and fifty-one (1, 451) consecutive patients were prospectively included in the study during two years (769 women, 59±14 years old). Death from any cause and nonfatal myocardial infarction (MI) were defined as primary end-points; revascularization cases were analyzed separately. Results: It was feasible to assess velocities in left-sided CA in 1, 231 patients (85%; 95% CI 83–87%). The feasibility was 82% during the first year and 90% during the second year. Over a median follow-up of 36 months, there were 42 deaths and 17 nonfatal MI and 198 patients underwent revascularization. Maximal proximal velocity (OR 1.01, CI 1.01–1.02, p<0.0006) and age (OR 1.07, CI 1.04–1.10, p<0.0001) were proven to be independent prognostic predictors of mortality. Maximal proximal velocity (OR 1.02, CI 1.01–1.02, p<0.0001), ejection fraction (OR 0.98, CI 0.95–0.99, p<0.04), and age (OR 1.05, CI 1.03–1.08, p<0.0003) were independent prognostic predictors for death/MI. Maximal proximal velocity (OR 1.02, CI 1.01–1.02, p<0.0001), smoking (OR 1.6, CI 1.1–2.4, p<0.02), and diabetes mellitus (OR 1.75, CI 1.2–2.4, p<0.003) were independent prognostic predictors for revascularization. The cut-off value for maximal proximal for predicting death within 36 months was 67 cm/s. Sensitivity was 67% and specificity was 75%, with an area under the ROC curve of 0.77, p<0.0001. Maximal velocity of 66 cm/s predicted death/MI with sensitivity 74%, specificity 75% (area under the ROC curve of 0.79, p<0.0001) were cut-off values. Conclusion: Assessment of left-sided CA during echocardiography is a feasible and prognostically valuable method. Accelerated velocity in proximal part of CA is associated with a poor prognosis. FUNDunding Acknowledgement: Type of funding sources: None.