Aug 2026· Journal of Clinical Medicine· Vol 15, pp. 6318· 0 citations· 38 references
Medicine
TL;DR
Higher CACS values were associated with lower conventional echocardiographic measures of right ventricular systolic function, but the present data do not establish CACS as a clinical predictor of right ventricular dysfunction or support its use for clinical decision-making.
Abstract
Background: Coronary artery calcium score (CACS) is a well-established marker of coronary atherosclerotic burden and cardiovascular risk. While its association with left ventricular dysfunction has been extensively investigated, the relationship between CACS and right ventricular (RV) function remains insufficiently explored. This study aimed to evaluate the association between CACS and echocardiographic RV function parameters and to explore the discriminatory ability of CACS for identifying patients meeting predefined echocardiographic thresholds of RV dysfunction in patients with suspected stable coronary artery disease (CAD). Methods: This retrospective observational study included 96 patients who underwent coronary computed tomography angiography and transthoracic echocardiography within a 3-month interval. CACS was calculated using the Agatston method. RV function was assessed using tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RV-FAC), and tissue Doppler-derived systolic velocity (S′). Correlation analyses, subgroup comparisons, multivariable linear regression, receiver operating characteristic (ROC) analyses, decision curve analysis (DCA), and calibration analyses were performed. Results: CACS demonstrated significant inverse correlations with TAPSE (r = −0.42, p < 0.001), RV-FAC (r = −0.36, p = 0.002), and S′ (r = −0.31, p = 0.006). Patients with higher CACS values exhibited progressively impaired RV systolic function. In multivariable regression analyses, higher CACS remained associated with lower TAPSE, RV-FAC, and S′ after adjustment for age, hypertension, and diabetes mellitus. Exploratory ROC analyses demonstrated moderate discriminatory performance, with AUC values ranging from 0.70 to 0.76. DCA suggested a potential net benefit across a range of threshold probabilities, while bootstrap calibration analysis demonstrated acceptable agreement between predicted and observed outcomes. Conclusions: In this retrospective single-center cohort, higher CACS values were associated with lower conventional echocardiographic measures of right ventricular systolic function. However, given the selected study population, relatively small sample size, limited clinical and instrumental characterization, potential residual confounding, and absence of external validation, these findings should be considered exploratory. The present data do not establish CACS as a clinical predictor of right ventricular dysfunction or support its use for clinical decision-making.
AIM
To investigate the relationship between coronary artery calcium (CAC) score and left ventricular global longitudinal strain (LV GLS) in patients with arterial hypertension who had a negative treadmill exercise stress test but mild to intermediate coronary stenosis on coronary computed tomography angiography (CCTA).
METHODS
A total of 53 hypertensive patients (mean age 54.8 ± 4.8 years; 50.9% male) with 30-50% coronary stenosis on CCTA were included. Patients with diabetes, malignancy, or established coronary/peripheral artery disease were excluded. CAC score, left ventricular ejection fraction (LVEF, Simpson's method), and LV GLS (speckle-tracking echocardiography) were measured. Groups were stratified by GLS (< 18.5% vs. ≥ 18.5%) and LVEF (< 60% vs. ≥ 60%), and CAC score differences were assessed using the Mann-Whitney U test.
RESULTS
The median CAC score was 27 (IQR 16-44.5), median LVEF 60% (IQR 58-63%), and mean GLS 19.37 ± 0.89%. No overall association was found between CAC score and LV function by LVEF or GLS. In patients with left anterior descending (LAD) stenosis (30-50%), reduced LV function was linked to significantly higher CAC score. Median CAC score was higher in patients with GLS ≤ 18.5% (157 vs. 44.5; p = 0.019) and LVEF <60% (157 vs. 44.5; p = 0.019). No significant associations were found in right coronary artery (RCA), circumflex artery (Cx), or three-vessel stenosis subgroups.
CONCLUSION
Higher CAC score in hypertensive patients with mild LAD stenosis and negative stress testing identify those at risk of subclinical LV dysfunction.
E. Begić, Ada Djozic, N. Mlaco-vrazalic et al.· Medicinski glasnik· 0 citations
Background and Objectives: Coronary artery disease may be difficult to detect by resting echocardiography when left ventricular ejection fraction is preserved and regional wall motion abnormalities are absent. This study aimed to assess whether resting Tissue Doppler Imaging-derived mitral annular velocities can help identify CAD in patients with suspected angina pectoris. Materials and Methods: We conducted a cross-sectional observational study of 92 patients hospitalized with suspected angina pectoris who underwent elective coronary angiography at the Institute of Cardiovascular Diseases in Timișoara (January 2025–February 2026). Patients with conditions known to affect TDI-derived parameters were excluded, including previous acute coronary syndrome or myocardial revascularization, significant valvular disease, cardiomyopathies, relevant arrhythmias or conduction abnormalities, permanent pacing, reduced ejection fraction, and pericardial disease. Laboratory and echocardiographic data were collected. ROC curve analysis, univariable logistic regression and multivariable logistic regression were performed to evaluate the diagnostic performance of TDI-derived parameters and their independent association with coronary artery disease. Results: Patients with CAD had significantly lower average E′ values (7.4 ± 1.9 vs. 8.9 ± 1.8 cm/s, p < 0.001) and average S′ values [7.0 (IQR 6.0–7.5) vs. 9.0 (IQR 8.1–10.0) cm/s, p < 0.001], together with higher E/E′ ratios [9.33 (IQR 8.23–11.15) vs. 7.87 (IQR 5.93–9.51), p = 0.002]. Average S′ showed the highest discriminative ability for coronary artery disease, with an AUC of 0.899 (95% CI: 0.819–0.952, p < 0.0001). The optimal Youden-derived cut-off was ≤7.5 cm/s, yielding 77.42% sensitivity and 93.33% specificity. After adjustment for age, male sex, body mass index, diabetes, smoking status, hypertension and LVEF, dichotomized S′ remained an independent predictor of coronary artery disease (OR = 45.49, 95% CI: 8.03–257.68, p < 0.0001), with an adjusted model AUC of 0.92 and 88.04% correct classification. Conclusions: TDI, particularly S′ velocity, may be a useful resting echocardiographic parameter for identifying CAD in selected patients with preserved LVEF and no resting regional wall motion abnormalities. Rather than serving as a universal diagnostic marker, S′ should be considered a complementary, easily obtainable parameter that may improve non-invasive assessment in this specific clinical setting.
Andrei-Catalin Zavragiu, Petre-Adrian Barzache, D. Buzzi et al.· Medicina· 0 citations
Routinely available ECG-derived P-wave dispersion and echocardiographic LAVI are independent, complementary predictors of MACE in CAD patients, and integrating these two parameters into a simple risk model significantly enhances risk discrimination and reclassification, providing a practical, cost-effective tool for individualized management.
Qin Wu, Gang Chen, Jian Chang· Frontiers in Medicine· 0 citations
Coronary artery disease (CAD) is a leading cause of global morbidity and mortality, with progressive left ventricular dysfunction being a critical determinant of prognosis. Serial monitoring of cardiac function during guideline-directed medical therapy (GDMT) is essential, yet data on the short-term echocardiographic trajectory in a real-world setting are limited. Objective: This study aimed to prospectively assess changes in echocardiographic parameters of cardiac function in CAD patients over a standardized 12-week GDMT period. This prospective cohort study was conducted at International Medical College, Dhaka, Bangladesh, from January to December 2023. Using purposive sampling, 63 diagnosed CAD patients were enrolled. All participants received optimized GDMT per standard protocols. Transthoracic echocardiography was performed at baseline and after 12 weeks, with key measurements including left ventricular ejection fraction (LVEF), end-diastolic volume (LVEDV), end-systolic volume (LVESV), and E/e' ratio. Data were analyzed using SPSS version 23.0, employing paired t-tests for normally distributed data (p<0.05 considered significant). Among 63 patients (mean age 58.7±9.2 years, 68.3% male), significant improvements were observed in key echocardiographic parameters after 12 weeks. Left ventricular ejection fraction increased from 45.2±7.8% to 49.5±8.1% (p=0.003). Concurrently, left ventricular end-systolic volume decreased from 68.5±15.2 mL to 62.1±14.7 mL (p=0.010), and the average E/e' ratio declined from 12.4±3.1 to 10.8±2.9 (p=0.020). A 12-week course of guideline-directed medical therapy in CAD patients leads to significant early echocardiographic improvement in systolic and diastolic function. These findings support the utility of short-interval echocardiographic follow-up to objectively monitor therapeutic response.
CBMJ 2026 July: Vol. 15 No. 02 P:296-303
A. Manju, Fatema Akter, Kazi Mohammad Abdul Awal et al.· Community Based Medical Jour...· 0 citations
Electrocardiography (ECG) is recommended as first investigation for chronic coronary artery disease (CAD), often showing ST segment depression and/or T‐wave changes, which are nonspecific. We aimed to identify predictors of CAD presence and severity in patients with ST‐T changes undergoing elective coronary angiography (ECA).
In this prospective cross‐sectional study, 84 consecutive patients with ST‐T changes on ECG undergoing ECA were evaluated using clinical, electrocardiographic, conventional echocardiography, and speckle tracking parameters. Multivariable logistic and linear regression analyses were performed to identify independent factors associated with CAD presence and severity.
Of the 84 patients, 36 (42.9%) had significant CAD. The number of affected vessels was significantly associated with age, male sex, smoking, typical chest pain, WMSI, and LVGLS (all
p
≤ 0.01). In multivariable logistic regression, male sex (OR 2.89, 95% CI 1.36–6.11,
p
= 0.006), typical chest pain (OR 2.26, 95% CI 1.05–4.87,
p
= 0.04), and LVGLS (OR 2.11, 95% CI 1.41–3.13,
p
< 0.001) were independently associated with CAD. In multivariable linear regression, LVGLS (std
β
= 0.32,
p
= 0.001), sex (std
β
= 0.29,
p
< 0.001), smoking (std
β
= 0.22,
p
= 0.003), and WMSI (std
β
= 0.20,
p
= 0.039) were independently associated with the number of affected coronary vessels. LVGLS demonstrated excellent diagnostic performance (AUC = 0.89, 95% CI 0.82–0.97,
p
< 0.001).
In patients with ST‐T changes, LVGLS, male sex, and typical chest pain independently predict the presence of CAD, while LVGLS is also strongly associated with disease severity. LVGLS shows excellent discriminatory ability and may improve noninvasive risk stratification in this population.
Objective To investigate the associations of composite glucose–lipid metabolic indices and echocardiographic parameters with coronary heart disease (CHD), and to determine whether integrating metabolic burden and cardiac function could improve pre-angiographic risk stratification and reflect coronary lesion severity. Methods This cross-sectional study consecutively enrolled 1,061 patients with chest pain who underwent coronary angiography at the First Hospital of Shanxi Medical University. CHD was defined as ≥50% stenosis in at least one major epicardial coronary artery. Composite metabolic indices, including the triglyceride-glucose index (TyG), TyG-BMI, METS-IR, atherogenic index of plasma, remnant cholesterol, and lipoprotein combine index, were evaluated together with echocardiographic parameters. Multivariable logistic regression was used to identify independent correlates of CHD. Tertile analysis and restricted cubic spline models were applied to assess dose-response patterns and potential non-linearity. ROC curves were used to compare discriminatory ability, and Spearman's correlation together with the Gensini score was used to evaluate coronary atherosclerotic burden. Results Among 1,061 participants, 522 had CHD. After multivariable adjustment, TyG (OR = 1.588, 95% CI: 1.269–1.995) and left ventricular ejection fraction (LVEF; OR = 0.958, 95% CI: 0.943–0.973) remained the two strongest independent indicators of CHD (both P < 0.001). TyG showed an approximately linear positive association with CHD risk, whereas LVEF showed a non-linear inverse association. Adding both measures to the base clinical model increased the AUC from 0.655 to 0.694, with decision-curve analysis indicating a modest incremental net benefit, although overall discrimination remained moderate. The high-TyG/low-LVEF group had the highest estimated CHD probability and greatest angiographic disease burden, as quantified by the Gensini score. Conclusion TyG and LVEF are routinely available, complementary measures of metabolic burden and systolic function. Both were independently associated with angiographically defined CHD, while the high-TyG/low-LVEF phenotype showed greater coronary burden. Their joint assessment modestly improved discrimination and may inform exploratory pre-angiographic evaluation in chest-pain patients.
Xing-Xing Che, Meng-Ting An, Wenkai Liu et al.· Frontiers in Cardiovascular...· 0 citations
