Usefulness of the two-dimensional echocardiogram in the diagnosis of severe coronary stenosis in patients with acute coronary syndrome without ST-segment elevation

Introduction:

Echocardiogram in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) can detect the location and extent of wall motion abnormalities and thus infer the severity of coronary lesions.

Objective:

To determine the validity of the two-dimensional echocardiogram in the diagnosis of severe coronary stenosis (SCD) in patients with NSTEACS.

Method:

Observational, analytical, cross-sectional study in 108 patients with NSTEACS, where echocardiogram was performed prior to coronary angiography. Subsequently, concordance was sought between both tests and the validity and safety of the echocardiogram in the diagnosis of ECS was determined.

Results:

Sensitivity of 61.7%, specificity of 64.29%, positive predictive value (PPV) 92.06% and negative predictive value (NPV) 20%. Sensitivity decreased as the number of coronary arteries with severe lesions increased, while specificity increased (97.06% in three-vessel disease).

Conclusions:

The echocardiogram did not have high sensitivity or specificity in the diagnosis of ECS; however, in the presence of altered regional contractility, the existence of an ECS due to high PPV is highly likely. Specificity was high for three-vessel disease, so it may help to exclude this entity.

Liliam G. Cisneros-Sánchez, Geovedy Martínez-García, Lázaro Puig-Benítez, Annia Ma. Carrero-Vázquez, Rosa Ma. Martínez-Peró, Taimara Pérez-Rivero

Coronary Care Unit, Enrique Cabrera General Teaching Hospital, Havana, Cuba