Longitudinal strain measured by two‐dimensional speckle tracking echocardiography to evaluate left ventricular function in patients with myocardial bridging of the left anterior descending coronary artery

Abstract

Objectives Myocardial bridging (MB) can cause myocardial ischemia, myocardial infarction, or even sudden cardiac death. We aimed to evaluate the left ventricular function in patients with MB of the left anterior descending coronary artery (LAD) using longitudinal strain (LS) measured by two‐dimensional speckle tracking echocardiography. Methods We enrolled 46 subjects with MB in the LAD diagnosed by coronary angiography. Patients were categorized into two groups according to the severity of tunneled artery stenosis: <50% as group I (23 patients) and ≥50% as group II (23 patients). Twenty‐five gender‐ and age‐matched subjects without MB confirmed by coronary angiography or with normal results on treadmill exercise test were included as controls. Two‐dimensional strain software was applied to measure the territories systolic average peak LS of the LAD coronary artery (LAD‐TPLS), right coronary artery (RCA‐TPLS), and left circumflex coronary artery (LCX‐TPLS) and to measure the global systolic peak LS of left ventricle (LV‐GPLS). Results The ratio of mitral peak early (E) and late (A) filling velocity (E/A) and the average mitral annular velocity (e′) were lower, and the mitral E/e′ ratio was higher in group II than in group I and controls (P < 0.05). LV‐GPLS and LAD‐TPLS were significantly less negative in group II than in group I and controls (LV‐GPLS: −19.77 ± 1.60% vs −21.10 ± 1.91% and −21.76 ± 1.23%; LAD‐TPLS: −19.24 ± 2.22% vs −22.00 ± 2.22% and −22.74 ± 1.82%, P < 0.001). The systolic compression severity of the tunneled artery was significantly correlated with LAD‐TPLS (r = −0.56, P < 0.001), but less strongly correlated with LV‐GPLS (r = −0.40, P < 0.05). The area under the curves of LAD‐TPLS was larger than that of LV‐GPLS; a cutoff value for LAD‐TPLS of −21.68% had 91.3% sensitivity and 73.9% specificity for detection of ≥50% of the tunneled artery stenosis. Conclusions In patients with ≥50% systolic narrowing of the tunneled artery, left ventricular systolic function and diastolic function were impaired, and the LAD‐TPLS is an excellent predictor of ≥50% systolic narrowing of the tunneled artery in patients with MB of the LAD.

Echocardiographic Parameters Predict Short- and Long-Term Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction

“…14 The ratio of early transmitral flow velocity to spectral pulse wave Tissue Doppler imaging (TDI) showed that early diastolic velocity of mitral annulus (E/E') was correlated accurately with the LV filling pressures degree and is a good predictor of the prognosis after the onset of AMI. 15 Our results indicated that E/E'>15 was related to 5-year MACEs. The E/E' ratio should be used to estimate LV filling pressure in AMI patients with impaired or normal LVEF when the transmitral pattern was nonrestrictive and increased LV filling pressure cannot be diagnosed by the simple transmitral flow assessment.…”

Echocardiographic changes and quality of life after surgical unroofing of myocardial bridges

“…Notably, this is the first study to confirm that a subtle form of myocardial contractility impairment may be found in patients with MBs, 8 even in the presence of apparently normal cardiac function and OMT. We also demonstrated that surgical unroofing of MBs provides better QoL with less physical limitation and a lower angina frequency than does OMT in adults and adolescents.…”

“… 3 , 7 Left ventricular (LV) dysfunction, myocardial stunning, and exercise-induced ventricular tachycardia may also be documented in patients with MBs. 2 , 8 , 9 …”

“…3,7 Left ventricular (LV) dysfunction, myocardial stunning, and exercise-induced ventricular tachycardia may also be documented in patients with MBs. 2,8,9 A resting electrocardiogram (ECG) is frequently normal, while stress tests may induce nonspecific signs of ischemia or arrhythmias. 3 Evaluation of myocardial ischemia can be particularly challenging in this context; perfusion defects are not usual and can be detected by myocardial scintigraphy.…”