Effectiveness of Resting Transthoracic Echocardiography at Detecting Significant Coronary Artery Disease in Adults

Abstract Background: Detection of the regional wall motion abnormalities (RWMA) on the transthoracic echocardiography (TTE) is commonly used to correlate with coronary artery disease (CAD) and often prompts a further workup, including cardiac computed tomography or cardiac catheterization. However, the RWMA do not consistently predict obstructive CAD. This study investigates the accuracy and reliability of the presence of the RWMA on the TTE at detecting significant CAD (≥70% vessel stenosis). Materials and Methods: A retrospective chart review was conducted on the adults seen by the Baylor Scott and White Temple Echocardiography Laboratory who received a resting TTE followed by a cardiac catheterization within 30 days over 4 years. The exclusion criteria included catheterization without coronary angiography and a prior history of CAD, percutaneous coronary intervention, or coronary artery bypass graft. We analyzed the RWMA on the TTE and atherosclerotic CAD on the cardiac catheterization to assess correlation. Results: Four hundred and thirty-five patients were included in the study, and 198 patients received ultrasound-enhancing agent (UEA). The sensitivity and specificity of the RWMA on the TTE for detecting CAD in the adults were 49.5% and 78.8%, respectively. The positive and negative likelihood ratios were 2.33 and 0.641, respectively. The use of UEA made no significant difference in the sensitivity or specificity. Discussion: Our results show that the presence of the RWMA on the TTE has a high ability to rule in CAD, but the absence of the RWMA displays a much lower ability to rule out CAD than previously reported. Our results also show UEA did not enhance or detract from the sensitivity or specificity of TTE on CAD. The clinicians should be aware that the presence of the RWMA on the resting TTE has a high association with obstructive CAD, but the absence of the RWMA does not sufficiently exclude CAD.