Incremental Value of CHA2DS2-Vasc Score in Boosting the Diagnostic Performance of Dobutamine Stress Echocardiography

Abstract

Background: Stress echocardiography today is a robust imaging modality used for diagnosing coronary artery disease (CAD). The  CHA2DS2-VASc score is a validated risk score, its utility has been expanded beyond predicting the stroke risk in patients with atrial  fibrillation to CAD prediction and risk assessment in many studies. We hypothesized that calculation of CHA2DS2-VASc score in cases with  positive DSE for coronary ischemia may provide an incremental value in improving the diagnostic accuracy of DSE and predicting truly  positive cases.

Methods: Our cross-sectional study involved 60 patients who received positive DSE results for coronary ischemia and  underwent subsequent coronary angiography, they were divided according to the presence of CAD as true positive and false positive  groups. CHA2DS2⌐VASc score was calculated and correlated to the wall motion score index at peak stress and the presence of CAD.  

Results: We observed a significant association between CHA2DS2⌐VASc score ≥2 and the presence of CAD, p=0.001. Also, combining the  WMSI at cut of >1.17 and CHA2DS VAS2C score ≥ 2 revealed a sensitivity of 80.5%, a specificity of 79%.and 80% accuracy and PPV of 89.2%  for prediction of truly positive CAD in patients with positive DSE,

Conclusions: We can conclude that the addition of the CHA2DS2⌐VAS2C  score to the DSE positive model can improve the diagnostic accuracy of the test and its predictive value for true positive cases.