Evaluation of left ventricular myocardial mechanics by three-dimensional speckle tracking echocardiography in the patients with different graded coronary artery stenosis

Abstract

To investigate the relationship between left ventricular (LV) myocardial mechanics evaluated by three-dimensional speckle tracking echocardiography (3D-STE) and degree of coronary artery stenosis in patients with coronary artery disease (CAD). Ninety-seven suspected CAD patients without LV regional wall motion abnormality (RWMA) observed visually form traditional echocardiography were divided into four groups according to coronary artery angiography (CAG): 23 patients in slight stenosis group [stenosis rate (SR) ≤25%], 26 patients in mild stenosis group (25< SR ≤50%), 28 patients in moderate stenosis group (50< SR ≤75%), and 20 patients in severe stenosis group (SR >75%). Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), area strain (AS) and three dimensional strain (3D-Strain) were obtained. The parameters from 3D-STE were compared between different groups and then the diagnostic value of global strains indicating different graded coronary artery stenosis was analyzed by the receiver operating characteristic curve. (1) There were significant difference in GLS, GCS, GRS, GAS and 3D-Strain between the severe stenosis group and any other group while all 3D-STE parameters except GCS in the moderate stenosis group were remarkably different from those respectively in mild group. (2) Receiver operator characteristic curve (ROC) analysis showed that the area under the curve of GLS, GRS, GCS, GAS, 3D-Strain were 0.899, 0.873, 0.723, 0.856 and 0.863 respectively for the identification of stenosis rate >50%, and 0.896, 0.866, 0.797, 0.909 and 0.899 respectively for the identification of severe stenosis. GAS less than -29.13% allowed a sensitivity of 95% and a specificity of 71.4%, while 3D strain less than 41.35% allowed a sensitivity of 90% and a specificity of 80.5% for evaluating serve coronary artery stenosis. The myocardial mechanics from 3D-STE in the CAD patients were characteristic. It could be expected to identify serve coronary stenosis with a good sensitivity and an acceptable specificity by using GAS or 3D-strain especially in the suspected CAD patients without RWMA on conventional echocardiography.

Assessment of Regional Left Ventricular Myocardial Strain in Patients with Left Anterior Descending Coronary Stenosis Using Computed Tomography Feature Tracking

“…Using the same method, You et al [20] found that LS was signi cantly reduced in myocardial segments supplied by coronary arteries with ≥75% stenosis compared with those subtended by coronary arteries with 75% stenosis and those in the control group. However, in a recent study, signi cant differences in 3D-STE parameters (GLS, GCS, GRS, area strain) were found between the severe and moderate stenosis groups and the slight and mild stenosis groups by Li et al [21]. Meanwhile, Deng et al [22] showed that patients with mild single vessel coronary artery stenosis had decreased area strain at the involved segments using four-dimensional echocardiography.…”

Left ventricular dyssynchrony in coronary artery disease patients without regional wall‐motion abnormality: Correlation with Gensini score

“…Since LV mechanical activation is triggered by the rapid propagation of electrical signals via a specialized conduction system, the early impaired myocardial perfusion in non‐RWMA CAD patients may damage the synchronization of LV mechanical activity by reducing electromechanical coupling and LV coordination. In addition, our previous study evaluated left ventricular myocardial mechanics using 3D speckle tracking echocardiography in CAD patients and detected a correlation between myocardial mechanical strain and the severity of coronary artery stenosis. In conclusion, we speculate that the prolongation of LVD in CAD patients may be related to impair electromechanical coupling and the change of left ventricular myocardial mechanics.…”

Early Diagnosis of Cardiovascular Diseases in Workers: Role of Standard and Advanced Echocardiography

“…The use of deformation (“strain”) echocardiography allows less subjective assessment of myocardial contraction as compared to simple visual evaluation [ 33 – 36 ]. The strain and strain rate derived from two-dimensional speckle tracking echocardiography (2DSTE) are based on computer algorithms tracking the movement of the so-called “speckles,” clusters of natural acoustic markers generated within the myocardium by an interaction with ultrasonic waves ( Figure 1 ).…”

“…Three-dimensional speckle tracking echocardiography (3DSTE) has recently been regarded as a more promising technique to accurately and reproducibly evaluate the segmental and global LV function [ 36 ]. The 3D mode avoids foreshortening of apical views, consumes less time in data acquisition, helps to solve the problem of out-of-plane motion present in the 2D modality tracking motion of speckles in all three dimensions, needs one single apical 4-chamber view to carry out all the analysis, and has good reproducibility as automated method as shown by the lower intraobserver and interobserver variability.…”