Please use this identifier to cite or link to this item:
https://repository.monashhealth.org/monashhealthjspui/handle/1/37507
Title: | Is exercise stress echocardiography useful in patients with suspected obstructive coronary artery disease who have resting left bundle branch block?. | Authors: | Mottram P.M.;Dobson L.;Nasis A. ;Moir S.;Cameron J. ;Xu B. | Institution: | (Xu, Dobson, Mottram, Nasis, Cameron, Moir) MonashHeart, Monash Health, Clayton, VIC, Australia | Issue Date: | 12-Apr-2018 | Copyright year: | 2018 | Publisher: | John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com) | Place of publication: | United States | Publication information: | Clinical Cardiology. 41 (3) (pp 360-365), 2018. Date of Publication: March 2018. | Journal: | Clinical Cardiology | Abstract: | Background: Current guidelines support exercise stress echocardiography (ESE) for evaluation of suspected obstructive coronary artery disease (OCAD) in ambulant patients with left bundle branch block (LBBB). Data regarding the diagnostic utility of ESE in patients with LBBB are limited. Hypothesis: We hypothesized that the diagnostic performance of ESE for the assessment of suspected OCAD is reduced in the context of LBBB. Method(s): We studied 191 consecutive patients with resting LBBB undergoing ESE for the investigation of suspected OCAD between 2008 and 2015 at our center. The studies were categorized as inconclusive, normal, or abnormal. Patients with an abnormal response were subcategorized as regional ischemic response or globally abnormal. Result(s): Eighty-two patients (43%) demonstrated a normal left ventricular contractile response (LVCR) to exercise; 92 (48%) developed an abnormal LVCR to exercise, including 70 patients with globally abnormal and 22 patients with regional ischemic responses. Of the patients with abnormal responses, 62 patients had anatomic imaging, only 29 of whom had significant OCAD, conferring an overall specificity of ESE for significant OCAD of 21% and accuracy of 52%. Of patients who developed a regionally abnormal response, 89% had significant OCAD. Conclusion(s): For patients with LBBB who develop a globally abnormal LVCR during ESE, the specificity of ESE for reliably excluding significant OCAD is significantly reduced. ESE appears to be a suboptimal test for the evaluation of OCAD in patients with resting LBBB, as about 50% of patients will have an abnormal response, the majority due to globally abnormal contraction where OCAD cannot be reliably diagnosed. Alternative testing should be considered for the investigation of suspected OCAD in patients with resting LBBB.Copyright © 2018 Wiley Periodicals, Inc. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1002/clc.22875 | ORCID: | Xu, Bo; ORCID: http://orcid.org/0000-0002-2985-7468 | Link to associated publication: | Click here for full text options | PubMed URL: | 29574887 [http://www.ncbi.nlm.nih.gov/pubmed/?term=29574887] | ISSN: | 0160-9289 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/37507 | Type: | Article | Subjects: | controlled study coronary angiography *coronary artery obstruction/di [Diagnosis] *diagnostic value disease classification electrocardiography *exercise test female *heart left bundle branch block heart left ventricle contraction heart muscle ischemia/di [Diagnosis] human major clinical study male myocardial disease/di [Diagnosis] patient referral reliability reproducibility retrospective study *stress echocardiography echocardiograph *exercise stress echocardiography Vivid 7 Vivid E9 adult aged article cohort analysis heart muscle ischemia / diagnosis human major clinical study male myocardial disease / diagnosis patient referral reliability reproducibility retrospective study *stress echocardiography *diagnostic value disease classification coronary angiography controlled study cohort analysis Article aged adult *coronary artery obstruction / *diagnosis electrocardiography *exercise test female *heart left bundle branch block heart left ventricle contraction |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
Show full item record
Items in Monash Health Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.