Appropriate use criteria implementation with modified Haller index for predicting stress echocardiographic results and outcome in a population of patients with suspected coronary artery disease

<p>Raw data related to the article</p> <p>Abstract<br> The hypothesis that modified Haller index (MHI) integration with the existing appropriate use criteria (AUC) categories may<br> predict exercise stress echocardiography (ESE) results and outcome of patients with suspected coronary artery disease (CAD)<br> has never been previously investigated. We retrospectively analyzed 1230 consecutive patients (64.8 &plusmn; 13.1 years, 58.9%<br> men) who underwent ESE for suspected CAD between February 2011 and September 2019 at our institution. MHI (chest<br> transverse diameter over the distance between sternum and spine) was assessed in all patients. A true positive (TP) ESE was<br> a positive ESE with obstructive CAD according to subsequent coronary angiography. During follow-up time, we evaluated<br> the occurrence of any of the following: (1) cardiovascular (CV) hospitalizations; (2) Cardiac death or sudden death. Overall,<br> 734 (59.7%), 357 (29.0%) and 139 (11.3%) indications for ESE were classified as appropriate (Group 1), rarely appropriate<br> (Group 2) and which may be appropriate (Group 3), respectively. A funnel chest (defined by an MHI &gt; 2.5) was detected<br> in 30.3%, 82.1% and 49.6% of Groups 1, 2 and 3 subjects, respectively (p &lt; 0.0001). On multivariate logistic regression<br> analysis, male sex (OR 1.41, 95%CI 1.02&ndash;2.03, p = 0.01) and type-2 diabetes (OR 3.63, 95%CI 2.49&ndash;5.55, p = 0.001) were<br> directly correlated to a TP ESE, while &ldquo;rarely appropriate&rdquo; indication for ESE with MHI &gt; 2.5 (OR 0.16, 95%CI 0.11&ndash;0.22,<br> p &lt; 0.0001) showed a significant inverse correlation with the outcome. During a mean follow-up of 2.5 &plusmn; 1.9 years, 299 CV<br> events occurred: 76.4%, 3.5% and 20.1% in Groups 1, 2 and 3, respectively. On multivariate Cox regression analysis, smoking<br> (HR 1.33, 95%CI 1.19&ndash;1.48), type 2 diabetes (HR 2.28, 95%CI 1.74&ndash;2.97), dyslipidemia (HR 3.51, 95%CI 2.33&ndash;5.15), betablockers<br> (HR 0.55, 95%CI 0.41&ndash;0.75), statins (HR 0.60, 95%CI 0.45&ndash;0.80), peak exercise average E/e&prime; ratio (HR 1.08, 95%CI<br> 1.06&ndash;1.09), positive ESE (HR 3.12, 95%CI 2.43&ndash;4.01) and finally &ldquo;rarely appropriate&rdquo; indication for ESE with MHI &gt; 2.5<br> (HR 0.15, 95%CI 0.08&ndash;0.23) were independently associated with CV events. The implementation of AUC categories with<br> MHI assessment may select a group of patients with extremely low probability of both TP ESE and adverse CV events over<br> a medium-term follow-up. A simple noninvasive chest shape assessment could reduce unnecessary exams.</p>