Impact of coronary stenosis location on global left ventricular myocardial strain in patients with moderate pretest probability of coronary artery disease
TL;DR
In patients with moderate pretest probability (PTP) of CAD, global left ventricular myocardial strain depends not only on the presence of hemodynamically significant coronary stenosis but also on its location.
Abstract
Aim . To study the impact of hemodynamically significant coronary stenosis location on global left ventricular myocardial strain in patients with moderate pretest probability (PTP) of coronary artery disease (CAD). Material and methods . The study included 79 patients with moderate PTP of CAD (median age, 62,0 years; men, 52) who underwent stress echocardiography followed by invasive coronary angiography within 2 months. After stress echocardiography, global longitudinal strain (GLS) and global postsystolic index (GPSI) were determined using speckle‑tracking echocardiography. Hemodynamically significant coronary stenoses were detected in 53 patients, including stenosis of the left anterior descending (LAD) artery in 23 patients, left circumflex (LCx) artery in 16 patients, and right coronary artery (RCA) in 14 patients. Results . In patients with coronary stenosis, median GLS values were lower than in patients without stenosis at rest (18,8 vs 21,9%, p=0,0003) and after exercise (20,3 vs 24,3%, p=0,0001). Median GPSI values were higher in stenosis than without it (at rest 2,94 vs 1,62%, p=0,0091, after exercise 7,88 vs 1,35%, p<0,0001). The resting GLS values for LAD, LCx, and RCA stenosis were 18,4%, 18,5%, and 20,0% (p=0,0008), while after exercise they were 16,9%, 21,1%, and 24,3% (p<0,0001), respectively. The corresponding resting GPSI values were 2,88%, 5,18%, and 2,77% (p=0,0126), while after exercise they were 8,24%, 7,85%, and 4,59% (p<0,0001), respectively. In RCA stenosis, the resting and post‑exercise GLS values and the resting GPSI value did not differ significantly from those in patients without coronary stenosis. Conclusion . In patients with moderate pretest probability (PTP) of CAD, global left ventricular myocardial strain depends not only on the presence of hemodynamically significant coronary stenosis but also on its location. The most pronounced decrease in GLS and increase in GPSI are observed with LAD stenosis, while the least pronounced increase is observed with RCA stenosis.