Assessment of the probability of obstructive coronary artery disease in patients with paroxysmal dyspnea due to myocardial ischemia

Aim. To characterize the potential of assessing the probability of obstructive coronary atherosclerosis in patients with stable coronary artery disease (CAD) and paroxysmal dyspnea due to myocardial ischemia.

Material and methods. In a cross-sectional study of 36 stable patients with CAD, complaining of paroxysmal dyspnea during stress echocardiography, transient myocardial ischemia was detected. According to coronary angiography data, coronary artery stenosis ≥50% was detected in 30 (83,3%) of them: ≥70% — in 25 (69,4%), ≥90% — in 18 (50,0%) patients.

Results. Independent parameters associated with stenosis ≥50% were a lower anxiety-depression scale score, the presence of pathological Q waves and higher e'lateral (early diastolic mitral annular velocity along the left ventricular lateral wall); for ≥70% — no bendopnea, greater duration and severity of dyspnea, a history of coronary stenting, no prior paroxysmal atrial fibrillation and a higher e'lateral; for stenosis ≥90% — greater severity of dyspnea, lower scores on the visual analogue scale of depression and greater e'lateral. The area under the characteristic curve when predicting stenosis ≥50% was 0,81 for the regression equation and 0,68 for the point scale, while ≥70% — 0,91 and 0,71, ≥90% — 0,82 and 0,75, respectively.

Conclusion. The most informative indicators of obstructive CAD in the studied patients were a longer duration and severity of dyspnea, a low anxiety-depression scale score, as well as the absence of left ventricular diastolic dysfunction.

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