Diagnostic value of the left ventricular contractile reserve for the detection hemodynamically significant coronary artery stenosis

Abstract

Introduction. Previous studies have shown that the value of left ventricular contractile reserve (LV CR) during stress echocardiography is an important prognostic indicator for heart failure (1). The diagnostic value of LV CR for the evaluation of haemodynamically significant coronary artery (CA) stenosis has so far been applied only in small sample studies and remains uncertain (2). Research aim. To evaluate the diagnostic value of LV CR at rest and peak dobutamine dose, for the detection haemodynamically significant coronary artery stenosis, in patients with moderate probability of stable coronary artery disease (CAD). Research methods and organization. Dobutamine stress echocardiography and adenosine stress magnetic resonance imaging were performed in 55 patients with a moderate probability of CAD. Patients were divided into two groups: the non-pathological group (n = 30; 54.55%), consisting of patients with no haemodynamically significant CA stenosis and a pathological group (n = 25; 45.45%) - patients with at least one haemodynamically significant CA stenosis. Haemodynamically significant CA stenosis was established when ≥ 50% were detected during invasive coronary angiography (ICA) which heamodynamical significance was confirmed by the presence of perfusion defect during adenosine stress magnetic resonance test. LV systolic volume was evaluated in two-dimensional (2D) echocardiography images in two and four-chambers view. LV CR was calculated using the formula: LV CR = (sBP / LV / LV systolic volume at maximum dobutamine load) / (sBP / LV / LV systolic volume at rest) where: sBP / LV - systolic blood pressure of left ventricle. Statistical data analysis was performed using IBM SPSS 25.0 software package. The diagnostic importance of LV CR was assessed using ROC curve analysis. Differences were considered statistically significant when p <0.05. Results. There were no statistically significant difference in pa