Regional wall motion abnormalities in transthoracic echocardiography in patients with significant coronary artery disease and coronary collateral circulation in adults

• Published in: Cardiovascular revascularization medicine 2024-12, Vol.69, p.35-41
• Main Authors: Woods, Michael D., Hatfield, Jess, Hammonds, Kendall, Exaire, Jose, Mixon, Timothy A., Nguyen, Vinh, Chiles, Christopher, Widmer, Robert J.
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Catheterization; Collateral Circulation; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary Circulation; Coronary collateral circulation; Echocardiography; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Regional wall motion abnormalities; Reproducibility of Results; Resting transthoracic echocardiography; Retrospective Studies; Ventricular Function, Left
• ISSN: 1553-8389; 1878-0938; 1878-0938
• DOI: 10.1016/j.carrev.2024.05.023

Coronary collateral circulation is a common finding in patients with chronic total occlusions (CTOs) resulting from chronic coronary artery disease (CAD). Regional wall motion abnormalities (RWMA) on transthoracic echocardiography (TTE) can be used for the diagnosis of CAD. However, little work has been done to investigate the impact of collateral vessels on the diagnostic accuracy of resting TTE for CAD. A retrospective chart review was conducted of adults who received a resting TTE and cardiac catheterization within 30 days over a 4-year period at the Temple Baylor Scott & White echocardiography laboratory. Exclusion criteria included catheterization without coronary angiography and prior history of CAD, percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). We analyzed RWMA on TTE in patients with CAD and coronary collateral circulation on cardiac catheterization to assess for correlation. Of the 753 patients were included in this study, 453 had CAD, 272 had both CAD and RWMA, 111 had collateral circulation, and 73 had collateral circulation and RWMA. There was no significant difference in RWMA in patients with CAD with and without collateral circulation. There was no significant difference in the sensitivity (60.0 % vs 59.2 %) and specificity (78.4 % vs 73.9 %) after collateral-adjusted interpretation of RWMA and CAD (p = 0.3). Our results suggest the average coronary collateral system is of insufficient clinical significance to prevent the development of RWMA on resting TTE. •Current guidelines support the use of resting TTE in suspected occlusive coronary artery disease when data are insufficient to warrant cardiac catheterization.•However, do regional wall motion abnormalities (RWMA) on resting echocardiography (TTE) correlate with obstructive coronary disease (CAD) via angiography?•The sensitivity and specificity of RWMA on TTE for detecting CAD in adults was 49.5 % and 78.8 %, respectively.•There was no difference in patients with CAD or chronic total occlusions (CTOs) with collateral circulation in protecting from RWMAs.•Collateral circulation for CTOs might be insufficient to provide adequate blood flow to prevent against myocardial damage and revascularization should be considered.