Real-life data and the utility of echocardiography in young patients under 45 years with ischemic heart disease- a single-centered retrospective analysis
Authors: Dyankov K , Dimitrova V , Radkova M , Karamfiloff K 
Published: January 2025

Abstract

Background
In the last decade there is an increased incidence of coronary artery disease occurring in young adults ≤45-year-old who were referred for selective coronary angiography (SCAG). The traditional risk factors and approach are not informative and effective enough for adequate stratification and interventional referral.

Purpose
This study aims to measure the predictive value of the echocardiographic data added to the conventional approach for selection of invasive diagnostic procedures (symptoms, ECG, laboratory markers- hs-troponin and lipid profile, risk factors- sex, diabetes, smoking, etc.). Reduction of the overuse of angiography in young patients without added risk for their health is a priority.

Methods
We did a single-centered retrospective cohort study from January 1, 2019 to June 1, 2024 of young patients under 45 years-old who underwent coronary angiography. During this 5 years period, of the 5933 SCAGs performed in our center, 225 (225/5933; 3.8%) were patients ≤45 years who presented with symptoms of angina, had elevated hs-troponin T (over 0.014 ng/ml), ischemic ECG findings or had several risk factors such as sex, diabetes, LDL&gt; 3.0 mmol/l, smoking. Of all the young patients only 82 (82/225- 36.4%) were diagnosed with significant coronary artery disease (including unstable angina, STEMI, NSTEMI) and the data from this patient cohort was analyzed. Death, sex stratification, smoking, diabetes, number of diseased vessels were studied. The added value of echocardiographic evaluation with simple markers such as left-ventricular ejection fraction (LVEF), mitral (MR) and tricuspid regurgitation (TR) as a potential discriminator for significant CAD was evaluated.

Results
We identified 82 patients under age 45 with CAD diagnosed by coronary angiography. The sex stratification showed clear predominancy for male (n= 74, p=90.2%), death (n=4, p=4.9%), number of diseased vessels (one- n=28, p=34.1%; two- n=24, p=29.3%, three- n=30, p=36.6%) and the most common cardiovascular risk factors for significant CAD were dyslipidemia with LDL&gt; 3 (n=22, p=26.8%), diabetes (all n=35, p=42.7%), smoking (n=58, p=70.7%). To better recognize the full diagnostic capability of echocardiography, we performed thorough analysis of the selected sub-population with positive echo signs represented by LVEF, MR and TR. Overall, 29.3% had reduction in EF (n=24 with EF below 49%), 92.6% had MR I stage (n=76), 7.4%- MR II stage (n=6), 95.1%- TR I stage (n=78), 4.9%- TR II stage. The sub-population of 82 young patients with CAD were divided in two groups- patients with reduced and preserved EF. Only left-ventricular EF of the investigated echo markers showed statistical significance in the single-variable analysis (r = 0.20, P &lt; .0001) between the groups.

Conclusion(s)
When the predictive values of LVEF and risk factors- sex, diabetes, smoking and LDL are combined, the discrimination for the need of SCAG in young patients is more precise and clearer.
Flow chart 1