Longitudinal myocardial function is more compromised in cardiac syndrome X compared to insignificant CAD: Role of stress echocardiography and calcium scoring

Abstract

Background and Aim The aim of this study was to assess the nature of myocardial dysfunction in the cardiac syndrome X (CSX) and insignificant coronary artery disease (ICAD) using dobutamine stress echocardiography (DSE) and coronary calcium scoring (CAC). Methods We prospectively studied 35 consecutive patients who complained of exertional angina, had ≥1 mm ST shift on exercise stress test but normal or no obstructive CAD (<50%) on angiography. Patients were divided into CSX (n = 27) with normal arteries and ICAD (n = 8) with insignificant stenosis. Results CSX patients had more females, lower calcium score and less prevalent cardiac risk factors compared to ICAD (p < 0.05 for all). At peak stress, MAPSE and TAPSE failed to increase in both groups. LV septal and lateral s’ increased in the two groups but the increment increase was less in CSX than ICAD (p < 0.05) while other diastolic indices did not differ between groups (p > 0.05 for all). CAC correlated modestly with LV and RV systolic velocities: septal s' (r = −0.65, p < 0.001) lateral s' (r = −0.35, p = 0.04) and right s' (r = −0.53, p = 0.005) in CSX, while in ICAD patients only with RV s' (r = −0.58, p = 0.02). On multivariate model, only septal s' OR 1.816 (1.1090–3.820, p = 0.04) proved the most powerful independent predictor of CAC. Conclusions Compromised LV longitudinal systolic velocities were more pronounced and calcium score as a surrogate for atherosclerosis was lower in CSX than ICAD. These findings strengthen the evidence for different pathogenesis of CSX compared to ICAD, with microvascular disease in the former and calcification in the latter.

Percutaneous Coronary Intervention Is Not Superior to Optimal Medical Therapy in Chronic Coronary Syndrome: A Meta-Analysis

“…Some of these patients may show extensive calcification but no single flow limiting lesion. The extensive calcification itself can be the cause of recurrent CCS through minimizing coronary flow reserve [ 47 , 48 ].…”

Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis

“…In addition, the technique is free of radiation, in contrast with other functional tests, as well as simple in its application, with a small ultrasound probe placed on the chest without a need for large cameras [ 8 ] or claustrophobic tubes [ 9 ]. While the conventional DSE assessment of ischemia is based on the development of wall motion abnormalities at fast heart rate with respect to resting [ 10 ], other echocardiographic modalities have been used and proved to be better in objectively assessing myocardial ischemic dysfunction, including myocardial velocities [ 11 ], myocardial deformation in the form of strain and strain rate abnormalities and myocardial perfusion disturbances [ 12 , 13 ]. The aim of this study was to evaluate the accuracy of cardiac Doppler parameters in predicting the presence and significance of CAD.…”