Layer-specific analysis of left ventricular myocardial contractility in patients with coronary slow-flow phenomenon

Wang, Yonghuai; Ma, Chao; Zhang, Yan; Guan, Zhengyu; Liu, Shuang; Li, Yuling; Jun, Yang

doi:10.1002/jcu.22357

Cited by 9 publications

(15 citation statements)

References 22 publications

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“…[22][23][24] Previous studies have reported layer-specific strain differences in patients with a non-ST-segment elevation acute coronary syndrome and chronic ischemic cardiomyopathy. 25,26) Wang, et al 27) have analyzed the LV three-layer strain in patients with CSF; however, they did not show the layerspecific difference in the strain values reflecting the inhomogeneous pathologic change in the endocardium and the midwall layer, which was well evaluated in our study. 2D-STI has been performed extensively to evaluate LV function in various cardiac conditions.…”

Section: Discussioncontrasting

confidence: 53%

Early Assessment of Left Ventricular Function by Layer-Specific Strain and Its Relationship to Pulsatile Arterial Load in Patients with Coronary Slow Flow

et al. 2019

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Previous studies reported a controversial left ventricular (LV) function impairment and pathophysiology in patients with coronary slow flow (CSF). Greater arterial load has been shown to increase aortic impedance and endothelial shear stress, potentially affecting coronary anatomy and function. We investigated LV systolic function by a new layer-specific strain technology and assessed the association between pulsatile arterial load and contractility. A total of 70 patients with CSF and 50 controls with normal coronary angiography were included in the study. Layer-specific longitudinal and circumferential strains were assessed from endocardium, midmyocardium, and epicardium (global longitudinal strain (GLS)-endo, GLS-mid, GLS-epi and GCS-endo, GCSmid, GCS-epi) by two-dimensional speckle tracking imaging (2D-STI). Pulsatile arterial load was estimated by indexed arterial compliance (ACI). Layer-specific GLS showed a decreasing gradient from the endocardium to the epicardium in both the controls and CSF group. GLS-endo and GLS-mid in the CSF group were significantly lower than the control group (all P < 0.05). Layer-specific longitudinal strain showed a good correlation with the number of affected coronary arteries (all P < 0.05) and the mean thrombolysis in the myocardial infarction frame count (TFC) (all P < 0.05). ACI was lower in patients with CSF (P = 0.005), and ACI was correlated negatively with layer-specific GLS (all P < 0.05). Layer-specific evaluation of the LV provides an understanding of the layer-specific properties of the LV wall and the possible process of the LV impairment in patients with CSF. Greater pulsatile arterial load, as manifested by a lower ACI, is coupled with worse LV longitudinal function in patients with CSF.

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Section: Discussioncontrasting

confidence: 53%

Early Assessment of Left Ventricular Function by Layer-Specific Strain and Its Relationship to Pulsatile Arterial Load in Patients with Coronary Slow Flow

et al. 2019

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“…The greater the value of mTFC is, the more impaired the longitudinal systolic function of both ventricles (Figure ). This finding can be explained by the slower coronary flow (indicated by a greater mTFC), which represents more serious coronary artery involvement in patients with CSFP . In addition, slower coronary flow may affect the timely compensation of collateral circulation, which in turn may lead to myocardial ischemia and subclinical systolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…This finding can be explained by the slower coronary flow (indicated by a greater mTFC), which represents more serious coronary artery involvement in patients with CSFP. 31 In addition, slower coronary flow may affect the timely compensation of collateral circulation, which in turn may lead to myocardial ischemia and subclinical systolic dysfunction. This finding supports the long-term follow-up of CSFP patients, especially those with greater mTFC.…”

Section: Discussionmentioning

confidence: 99%

Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography

et al. 2018

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Objective This study aimed to determine whether STE could help detect subclinical myocardial dysfunction in patients with CSFP. Methods Sixty patients with CSFP confirmed by CAG and 51 controls with normal coronary flow were prospectively enrolled. Coronary angiographic data and conventional and speckle tracking echocardiographic parameters of the LV and RV were obtained for every subject. Results Compared with controls, CSFP patients presented with higher BMI and TG levels, but lower HDL‐C levels. Conventional echocardiographic parameters of biventricular systolic and diastolic function did not differ between the two groups (all P > 0.05). The GLS of the LV and RV was significantly impaired in CSFP patients compared with that in controls (−19.03% vs −21.42%, P < 0.001 and −19.72% vs −22.96%, P = 0.001, respectively). The myocardial impairment pattern of CSFP patients was homogenous in the RV and heterogeneous in the LV, where only endo‐ and mid‐myocardial layers were affected. LV‐GLS and RV‐GLS were found to be well correlated with mTFC and HDL‐C in CSFP groups (r = 0.463 vs r = 0.439; r = −0.569 vs r = −0.552, all P < 0.05). ROC curve analysis demonstrated that LV‐GLS‐endo had the highest AUC (0.867, P < 0.001) for predicting subclinical myocardial impairment in CSFP patients. Conclusions Subclinical myocardial systolic dysfunction occurs in both ventricles, and GLS could be an effective method to detect early‐stage myocardial impairment in patients with CSFP.

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“…Moreover, our previous study revealed that left ventricular (LV) systolic and diastolic functions in patients with CSFP are impaired at rest [8,9]. Therefore, patients with CSFP should receive close attention.…”

Section: Introductionmentioning

confidence: 99%

Value of exercise stress electrocardiography for stratification of exercise capacity and left ventricular systolic and diastolic function on coronary slow flow: Case-control study

Wang

Liu

et al. 2019

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Background Coronary slow flow phenomenon (CSFP) is an angiographic entity characterized by delayed coronary opacification in absence of evident obstructive lesion in the epicardial coronary artery. However, whether patients with CSFP exhibit differing responses to exercise is still not known. This study aimed to evaluate results of exercise stress electrocardiography (ExECG) and left ventricular (LV) function during exercise, and study the value of ExECG for stratification of exercise capacity and LV function in patients with CSFP.Methods Thirty patients with CSFP and 24 controls were enrolled in the study. Diagnosis of CSFP was made by Thrombolysis in Myocardial Infarction frame count. ExECG and LV function measured by echocardiography at rest, during exercise and recovery phase were evaluated.Results Negative ExECG was found in 24 (80%) patients with CSFP. At rest, LV global longitudinal strain (GLS) decreased and mitral average E/e’ increased in patients with CSFP compared with controls; however, there were no differences in these parameters between CSFP patients with negative ExECG and patients with positive ExECG. During exercise, CSFP patients with negative ExECG and controls had significantly increased LV GLS and decreased mitral average E/e’, but CSFP patients with positive ExECG had significantly decreased LV GLS and increased mitral average E/e’.Conclusions About 80% patients with CSFP exhibited negative ExECG. CSFP patients with negative ExECG exhibited improved LV function but CSFP patients with positive ExECG exhibited impaired LV function during exercise. ExECG may aid in the stratification of exercise capacity and LV function in patients with CSFP.

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Layer-specific analysis of left ventricular myocardial contractility in patients with coronary slow-flow phenomenon

Cited by 9 publications

References 22 publications

Early Assessment of Left Ventricular Function by Layer-Specific Strain and Its Relationship to Pulsatile Arterial Load in Patients with Coronary Slow Flow

Early Assessment of Left Ventricular Function by Layer-Specific Strain and Its Relationship to Pulsatile Arterial Load in Patients with Coronary Slow Flow

Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography

Value of exercise stress electrocardiography for stratification of exercise capacity and left ventricular systolic and diastolic function on coronary slow flow: Case-control study

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