Predictive value of combined electrocardiographic and echocardiographic parameters for major adverse cardiovascular events in patients with established coronary artery disease: a single-center retrospective cohort study

Echocardiographic Assessment of Cardiac Function in Coronary Artery Disease Patients over a 12-Week Treatment Period

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

Predictors of Coronary Artery Disease in Patients With ST ‐T Segment Alterations Undergoing Elective Coronary Angiography: The Role of Global Longitudinal Strain

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.

The predictive value of the TAPSE/PASP ratio for major adverse cardiovascular events in patients with chronic heart failure: evidence from a prolonged follow-up cohort

Abstract Background The tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio is a noninvasive surrogate of right ventricular–pulmonary arterial coupling. Previous evidence focused mainly on in-hospital, 90-day, or 1-year outcomes; long-term prognostic value across heart failure phenotypes remains unclear. Methods This cohort included 440 chronic heart failure patients admitted between 2019 and 2021. Median age was 67 years; 31.1% were female; median follow-up was 41 months. Restricted cubic spline analysis assessed association between TAPSE/PASP and major adverse cardiovascular events (MACEs), defined as all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, or heart failure rehospitalization. Kaplan–Meier and multivariable Cox regression analyses evaluated associations. Incremental value was assessed using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results During follow-up, 193 patients experienced MACEs. TAPSE/PASP showed an approximately linear inverse association with MACE risk, with an exploratory cut-off of 0.036. After adjustment including natriuretic peptides, each 0.01-unit increase in TAPSE/PASP was associated with lower MACE risk (HR 0.75, 95% CI 0.66–0.87; p = 6.02 × 10−5), whereas TAPSE/PASP ≤0.036 was associated with higher risk (HR 1.98, 95% CI 1.37–2.85; p = 2.57 × 10−4). Adding TAPSE/PASP modestly improved discrimination (C-statistic 0.80 vs. 0.77), reclassification (NRI 0.31), and IDI (0.04) (all p < 0.05). Associations were consistent across prespecified subgroups. Conclusions In chronic heart failure patients, lower TAPSE/PASP was independently associated with long-term MACE risk across LVEF-defined phenotypes. TAPSE/PASP may provide complementary prognostic information, but its clinical utility requires prospective external validation.

Ejection fraction and absolute delta troponin in the early emergency department assessment of high coronary disease burden in NSTEMI patients: a retrospective observational study.

BACKGROUND Patients with non-ST-segment elevation myocardial infarction (NSTEMI) are commonly evaluated first in the emergency department, where early estimation of coronary disease burden may support clinical risk assessment before invasive coronary angiography. This study investigated whether routinely available emergency department parameters, with particular emphasis on ejection fraction (EF) and absolute delta troponin, were associated with high angiographic coronary disease burden assessed by the Gensini score. METHODS This retrospective observational study included adult NSTEMI patients admitted to the emergency department of a tertiary care hospital between January 1, 2024, and May 1, 2025, who subsequently underwent coronary angiography. Patients were divided into low and high Gensini groups using a predefined threshold of 40. Demographic characteristics, comorbidities, laboratory variables, echocardiographic findings, and absolute changes in serial troponin measurements were compared between groups. Independent associations with the high Gensini category were evaluated using multivariable binary logistic regression. Receiver operating characteristic curve analysis was used to assess the discriminatory performance of EF and absolute delta troponin/100. RESULTS A total of 394 patients were included in the final analysis; 209 were classified into the low Gensini group and 185 into the high Gensini group. In the adjusted model, lower EF was independently associated with the high Gensini category (OR: 0.888; 95% CI: 0.859-0.918; p < 0.001), while higher absolute delta troponin/100 showed a positive independent association (OR: 1.161; 95% CI: 1.074-1.254; p < 0.001). Diabetes mellitus was also independently associated with the high Gensini category (OR: 1.851; 95% CI: 1.096-3.127; p = 0.021). EF and absolute delta troponin/100 both showed statistically significant discrimination for the high Gensini category, with AUC values of 0.783 and 0.758, respectively. CONCLUSIONS In NSTEMI patients evaluated in the emergency department, lower EF and higher absolute delta troponin were independently associated with high angiographic coronary disease burden. EF showed slightly higher discriminatory performance than absolute delta troponin/100. These findings suggest that EF and absolute troponin change may provide complementary information during early emergency department assessment before coronary angiography, although they should not be interpreted as validated predictors of clinical outcomes.

Clinical correlates of early post-PCI left ventricular ejection fraction in patients with STEMI: a single-center retrospective study.

INTRODUCTION Early left ventricular systolic dysfunction after primary percutaneous coronary intervention (PCI) remains common in ST-segment elevation myocardial infarction (STEMI) and is associated with adverse remodeling and heart failure. The clinical relevance of lipid markers and lipid ratios for characterizing early post-PCI ventricular dysfunction beyond angiographic and hemodynamic features remains uncertain. METHODS We conducted a single-center retrospective study of consecutive patients with STEMI undergoing emergency PCI at Nanjing BenQ Hospital (2014-2023). LVEF was assessed by transthoracic echocardiography 24-72 h post-PCI, and reduced LVEF was defined as < 50%. Lipids were measured from the first blood sample obtained on admission, and LDL-C/HDL-C and TG/HDL-C were calculated. Multivariable linear and logistic regression models with hierarchical adjustment (Model 2 additionally including log1p-transformed troponin I measured from the first blood sample obtained on admission) were used to identify factors associated with LVEF and reduced LVEF. Discrimination of lipid markers was evaluated using ROC analysis. RESULTS Among 254 patients, 45 (17.7%) had reduced LVEF. LAD as the infarct-related artery (IRA) was more frequent in the reduced-LVEF group (73.3% vs. 48.3%, P = 0.002). LAD-IRA was independently associated with lower LVEF (β = -5.240; P < 0.001) and higher odds of reduced LVEF (OR = 4.005; P < 0.001). Higher systolic blood pressure was associated with lower odds of reduced LVEF (P = 0.026). TG/HDL-C showed modest discrimination (AUC = 0.605), whereas LDL-C showed no meaningful discrimination (AUC = 0.492). CONCLUSION In PCI-treated STEMI, LAD culprit territory and admission systolic blood pressure were the main clinical correlates of early post-PCI LV dysfunction, whereas TG/HDL-C showed only modest discrimination and limited standalone clinical utility. These findings should be considered exploratory and hypothesis-generating.

A multivariate electrocardiographic predictive model for left ventricular hypertrophy in children with primary hypertension