Layer-specific strain analysis in patients with suspected stable angina pectoris and apparently normal left ventricular wall motion

Abstract

BackgroundNon-invasive imaging tests are widely used in the evaluation of stable angina pectoris (SAP). Despite these tests, non-significant coronary lesions are not a rare finding in patients undergoing elective coronary angiography (CAG). Two-dimensional (2D) speckle tracking global longitudinal strain (GLS) imaging is a more sensitive and accurate technique for measuring LV function than conventional 2D methods. Layer-specific strain analysis is a relatively new method that provides endocardial and epicardial myocardial layer assessment. The aim of the present study was to evaluate longitudinal layer-specific strain (LSS) imaging in patients with suspected SAP.MethodsPatients who underwent CAG for SAP were retrospectively screened. A total of 79 patients with no history of heart disease and wall motion abnormalities were included in the study. Forty-three patients with coronary lesions > 70% constituted the coronary artery disease (CAD) group and 36 patients without significant CAD constituted the control group. Layer-specific GLS transmural, endocardium, and epicardium values (GLS-trans, GLS-endo, and GLS-epi, respectively) were compared between the groups.ResultsPatients in the CAD group had significantly lower GLS values in all layers (GLS-trans: -18.2 + 2.4% vs -22.2 + 2.2% p < .001; GLS-endo: -20.8 + 2.8% vs -25.3 + 2.6%, p < .001; GLS-epi: 15.9 + 2.4% vs -19.5 + 1.9%, p < .001). Multivariate adjustment demonstrated GLS-trans as the only independent predictor of CAD [OR:0.472, CI (0.326–0.684), p < .001]. Additionally, the GLS values were all lower in myocardial perfusion scintigraphy (MPS) true-positive patients compared with MPS false-positive patients (GLS-trans: -17.7 ± 2.4 vs. -21.9 ± 2.4%, p < .001; GLS-endo: -20.2 ± 2.9% vs -24.9 ± 2.9%, P < .001; GLS-epi: 15.4 ± 2.6% vs. -19.2 ± 1.8%, P < .001).ConclusionResting layer-specific strain as assessed by 2D speckle tracking analysis demonstrated that GLS values were reduced in all layers of myocardium with SAP and with no wall motion abnormalities. LSS analysis can improve the identification of patients with significant CAD but further prospective larger scale studies are needed to put forth the incremental value of LSS analysis over transmural GLS.

Impact of the left anterior descending artery wrapping around the left ventricular apex on cardiac mechanics in patients with normal coronary angiography

“…"LAD wrapping" was defined as an LAD artery that perfuses at least one fourth of the LV inferior wall in the right anterior oblique and caudal projection, and it does not terminate at the apex but extends through the diaphragmatic surface. While LAD non-wrapping was defined when LAD does not expand on the diaphragmatic surface and terminates at the apex [1][2][3][4]. Angiographic data was reviewed by at least two experienced observers.…”

“…A normal coronary angiogram was defined as one with the absence of any identifiable pathology (comprises signs of atherosclerosis, spontaneous coronary spasm, or thrombosis) [1]. Entirely, patients had mild coronary artery atherosclerotic lesions with ≤ 50% diameter stenosis, were diagnosed as having an obstructive coronary disease and excluded from the study.…”

“…Nowadays, coronary artery disease represents 31% of deaths and the most important cause of morbidity and mortality all over the world [1]. The left anterior descending coronary artery (LAD) supplies blood flow to the greater part of the cardiac muscle.…”

Myocardial strain analysis as a non-invasive screening test in the diagnosis of stable coronary artery disease

“…Exercise tests are the first-line screening for most patients, but lower sensitivity and specificity sometimes limited them in CAD diagnosis even combined with myocardial perfusion imaging or echocardiogram. Furthermore, these tests are not practical for patients with mobility issues [ 4 , 5 ]. On the other hand, myocardial perfusion scans and CT angiography are expensive and pose the risk of radiation exposure [ 5 ].…”

Comparison of left ventricular deformity and twist parameters during Speckle Tracking with Philips iE33 and Affiniti 70 scanners

“…[3][4][5] Despite the attempts made to standardize the parameters of deformations, there are still substantial ranges of deformation measurements from various equipment manufacturers, which hampers direct comparison of results. [6][7][8][9][10][11][12][13][14] When comparing the reproducibility of the deformation parameters, the best result is obtained for the global parameters (global longitudinal deformation). The average absolute difference between repeated measurements of various parameters of longitudinal deformation is 1-14%.…”