Diagnostic Value of Regional Wall Motion Abnormalities on Resting Transthoracic Echocardiography for Coronary Artery Disease

• Published in: Echocardiography (Mount Kisco, N.Y.) N.Y.), 2024-11, Vol.41 (11), p.e70031-n/a
• Main Authors: Hatfield, Jess, Woods, Michael D., Pham, Alex, Mayo, Scott, Wahab, Laith, Hammonds, Kendall, Nguyen, Vinh, Widmer, Robert J.
• Format: Article
• Language: English
• Subjects: Aged; Coronary Angiography - methods; coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Echocardiography - methods; Female; Humans; Male; Middle Aged; Reproducibility of Results; Rest; Retrospective Studies; RWMA; Sensitivity and Specificity; STEMI; transthoracic echocardiography
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/echo.70031

ABSTRACT Purpose Regional wall motion abnormality (RWMA) on transthoracic echocardiography (TTE) is used as a clinical decision‐making tool to assess systolic function, but there is limited data regarding the validity of this tool to predict obstructive coronary artery disease (CAD). This study evaluates the utility of RWMA on TTE for detecting obstructive CAD in patients with no prior CAD history. Methods We retrospectively reviewed charts of adults who underwent resting TTE and coronary angiography within 30 days, analyzing RWMA in relation to angiographic luminal stenosis. Results Among 754 patients (mean age 62, 60% male), TTE sensitivity varied with timing relative to angiography: 68.7% after angiography versus 49.5% before. In ST‐elevation myocardial infarction (STEMI) patients (n = 126 after vs. n = 4 before), sensitivity was 89.8%. RWMA correlated with CAD severity, particularly in STEMI cases. Conclusions TTE specificity remains high, but sensitivity varies significantly by timing, with the highest sensitivity in STEMI patients. These findings could refine decision‐making in uncertain STEMI cases, supporting TTE as a valuable adjunctive diagnostic tool. Central illustration: Transthoracic echocardiography (TTE) sensitivity is greater in ST‐elevation myocardial infarction (STEMI) patients than in other patient populations. Patients receiving a TTE for a STEMI had a sensitivity of 89.8%. All other indications for TTE had a sensitivity of 48.5%. Nearly all STEMI patients had their TTE after angiography; this high sensitivity in STEMI patients skewed sensitivity up in the “TTE after angiography” group.