Utility of squatting stress echo in predicting significant angiographic coronary artery stenosis

Kurukkanparambil Sredharan Mohanan; Thengilan Saidalavi; Shajudeen

Volume : VI, Issue : XII, December - 2017

Utility of squatting stress echo in predicting significant angiographic coronary artery stenosis

Kurukkanparambil Sredharan Mohanan, Thengilan Saidalavi, Shajudeen

Abstract :

Stress echocardiography is one of the most useful non–invasive diagnostic modalities for detection and evaluation of coronary artery disease (CAD). However, dobutamine or exercise stress echocardiography remains underutilized due to its cost, time factor, potential complications and a need for specialized echo lab. So the search for new stress tests remains an important task in the diagnostics of coronary heart disease (CAD). Sharpey –Schafere et al (1) in a study of normal subjects, found that squatting caused an increase in systemic arterial pressure that was followed by adycardia. Squatting increases left ventricular afterload and preload and will produce regional wall motion abnormalities (RWMA) in patients with coronary artery disease by inducing subclinical segmental dysfunction in normal segments with stenotic coronary arteries (2–5).

Aim. To evaluate the utility of squatting stress echo in diagnosing significant angiographic coronary Objective: To study the development of new or worsening RWMA induced by squatting and its relation with significant angiographic coronary artery stenosis

Methods: We studied 53 consecutive patients who were scheduled to have coronary angiography for the evaluation of chest pain. Each patient had squatting stress echocardiography followed by CAG. For squatting stress echocardiography the echocardiogram in standard views was recorded in the supine position. The procedure was repeated during squatting for 3 minutes. Echocardiography was performed using standard protocol. The squatting stress echocardiograms were interpreted by an observer blinded to the results of coronary angiography.

Results: During squatting, new or worsening Wall Motion Abnormality developed in 34 patients. In these patients CAG showed obstructive CAD in at least one of the major epicardial coronary artery. 38 % have developed RWMA in LAD territory, 22%, 16% in LCX and RCA territory respectively. The sensitivity, specificity, and accuracy of squatting Echocardiography for diagnosis of CAD were 94.1%, 94.4 and 96.9%, respectively. It is found to have significant correlation between squatting stress Echocardiography and coronary angiogram for the diagnosis of CAD.

Conclusion: These data indicate that squatting echocardiography is a NOVEL modality in the diagnosis of coronary artery disease.