This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lu, C. Articles by L'Abbate, A. Search for Related Content PubMed PubMed Citation Articles by Lu, C. Articles by L'Abbate, A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH

(Circulation. 1995;91:1669-1675.)
© 1995 American Heart Association, Inc.

Articles

Complex Coronary Artery Lesion Morphology Influences Results of Stress Echocardiography

Presented at the 43rd Annual Scientific Session of the American College of Cardiology, Atlanta, Ga, March 14-17, 1994.

Chunzeng Lu, MD; Eugenio Picano, MD; Alessandro Pingitore, MD; Rosa Sicari, MD; Rossana Tongiani, MD; Marco Baratto, MD; Cataldo Palmieri, MD; Mario Marzilli, MD; Antonio L'Abbate, MD

From CNR, Institute of Clinical Physiology, Pisa, Italy.

Correspondence to Eugenio Picano, MD, Istituto di Fisiologia Clinica, CNR, Via Paolo Savi, 8, 56126 Pisa, Italy.

Background The likelihood of a positive response with dipyridamole stress echocardiography (DSE) is directly related to the extent and severity of angiographically assessed coronary artery disease. Whether coronary lesion morphology—a known predictor of adverse cardiac events—may also modulate stress echo results remains unknown. The objective of our study was to assess the relation between stenosis lesion morphology and stress echocardiographic results.

Methods and Results High-dose (up to 0.84 mg/kg over 10 minutes) DSE and coronary angiographic data of 68 in-hospital patients (39 with stable angina, 29 with angina at rest) with nonoccluding, single-vessel disease at angiography and no previous myocardial infarction were analyzed. DSE was performed in all patients within 3 days of coronary angiography. An angiographic lesion was considered complex when irregular borders and/or intraluminal lucencies suggestive of ulcer and/or thrombus were present. According to angiographic lesion morphology, two groups were identified: group 1, with simple coronary lesions, and group 2, with complex coronary lesions. The two groups were matched for number of patients (n=34 in each group), age (group 1, 59±9 versus group 2, 59±10 years, P=NS), and coronary artery stenosis severity by quantitative coronary angiography (group 1, 60±7% versus group 2, 58±6% diameter reduction, P=NS). The sensitivity of DSE was lower in patients of group 1 when compared with group 2 (53% versus 85%, P<.001). Among positive DSE, the low-dose (0.56 mg/kg over 4 minutes) positivity was less frequent in group 1 than in group 2 patients (17% versus 62%, P<.01). Exercise ECG was completed in 66 patients, and it was positive (>.1 mV ST-segment shift from baseline) in 20 out of 33 group 1 and in 22 out of 33 group 2 patients (61% versus 67%, P=NS). The peak rate-pressure product tended to be higher in group 1 than in group 2 patients (257±52 versus 240±64 mm Hgxbeats per minutex10², P=NS).

Conclusions In patients with single-vessel disease without coronary occlusion or previous myocardial infarction, coronary lesion morphology of the complex type is associated with a higher DSE sensitivity and with a greater prevalence of low-dose, positive responses. Presence of irregular plaque contours, not only plaque geometry, is important in modulating stress responses in the presence of angiographically assessed coronary artery disease.

Key Words: ischemia • stress • echocardiography • exercise • lesion

This article has been cited by other articles:

				S. Kruger, K.-C. Koch, I. Kaumanns, M. W. Merx, P. Hanrath, and R. Hoffmann Clinical Significance of Fractional Flow Reserve for Evaluation of Functional Lesion Severity in Stent Restenosis and Native Coronary Arteries Chest, September 1, 2005; 128(3): 1645 - 1649. [Abstract] [Full Text] [PDF]

				K C Koch, W M Schaefer, K Ersahin, B Nowak, S Krueger, U Buell, P Hanrath, and R Hoffmann Haemodynamic significance of stent lesions compared to native coronary lesions: a myocardial perfusion imaging study Heart, June 1, 2004; 90(6): 691 - 692. [Full Text] [PDF]

				L.A. Pierard Evaluating risk in unstable angina: role of pharmacological stress echocardiography Eur. Heart J., July 1, 2000; 21(13): 1041 - 1043. [PDF]

				A. Pingitore, E. Picano, A. Varga, G. Gigli, L. Cortigiani, M. Previtali, G. Minardi, M. Quarta Colosso, J. Lowenstein, W. Mathias Jr., et al. Prognostic value of pharmacological stress echocardiography in patients with known or suspected coronary artery disease: A prospective, large-scale, multicenter, head-to-head comparison between dipyridamole and dobutamine test J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1769 - 1777. [Abstract] [Full Text] [PDF]

				M.-J. Hung, C.-H. Wang, and W.-J. Cherng Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction? Chest, November 1, 1999; 116(5): 1224 - 1232. [Abstract] [Full Text] [PDF]

				B. D. Beleslin, M. Ostojic, A. Djordjevic-Dikic, R. Babic, M. Nedeljkovic, G. Stankovic, S. Stojkovic, J. Marinkovic, I. Nedeljkovic, J. Stepanovic, et al. Integrated evaluation of relation between coronary lesion features and stress echocardiography results: the importance of coronary lesion morphology J. Am. Coll. Cardiol., March 1, 1999; 33(3): 717 - 726. [Abstract] [Full Text] [PDF]

				C. Palmieri, M. P. R. Sicari, E. Picano, A. Biagini, and M. Marzilli Quantitative Assessment of Coronary Atherosclerotic Plaque Profile by Morphometric Analysis of Angiographic Images Angiology, November 1, 1996; 47(11): 1053 - 1059. [Abstract] [PDF]