Prediction of Coronary Artery Stenosis at Rest in Patients With Normal Left Ventricular Wall Motion

Abstract

SummaryNoninvasive detection of coronary artery stenosis usually requires a stress test in patients without left ventricular (LV) regional wall motion abnormalities (RWMA). In contrast, abnormal regional LV relaxation caused by ischemia may persist beyond recovery from transient ischemia. The aim of the present study was to determine whether segmental analysis of abnormal regional LV relaxation using the strain imaging diastolic index (SI-DI) at rest could predict coronary artery stenosis in the three major vessels in patients without LV dysfunction or RWMA. We performed 2D speckle tracking echocardiography and coronary angiography in 85 patients without RWMA with suspected coronary artery disease. Patients with LV dysfunction or acute coronary syndrome were excluded. Echocardiographic images of the LV were obtained in the apical 2-, 3-, and 4-chamber views and divided into 6 segments. In each segment, SI-DI derived from transverse strain imaging was determined. Forty-eight patients had significant coronary artery stenosis (≥ 70%). The optimal cutoff values of SI-DI were 60.5% in the mid anteroseptal segment for detecting left anterior descending artery stenosis (sensitivity, 83.3%; specificity, 81.1%), 60.5% in the basal anterolateral segment for detecting left circumflex artery stenosis (sensitivity, 80.9%; specificity, 90.3%), and 61.5% in the basal inferior segment for detecting right coronary artery stenosis (sensitivity, 74.1%; specificity, 77.8%). A segmental analysis of SI-DI at rest predicted coronary artery stenosis in the three major vessels in patients without RWMA. This noninvasive method may be useful for detecting coronary artery stenosis without a stress test. (Int Heart J 2013; 54: 266-272)

Diastolic Stunning as a Marker of Severe Coronary Artery Stenosis: Analysis by Speckle Tracking Radial Strain in the Resting Echocardiogram

“…Several studies have reported that longitudinal strain measured by 2DST echocardiography at rest was significantly lower in patients with advanced CAD and may be useful marker for detecting CAD . Our study demonstrated that SAX radial strain measured by 2DST also may be useful for detecting CAD.…”

“…And in rare case, cardiovascular complications such as myocardial infarction, severe arrhythmias, and even sudden death can occur. Several studies have reported that longitudinal strain measured by 2DST echocardiography at rest was significantly lower in patients with advanced CAD and may be useful marker for detecting CAD …”

Transient Ischemic Right Axis Deviation Tendency of the Frontal Plane QRS Axis in a Case of Inferior Myocardial Ischemia

“…In the setting of an emergency room, however, simple, rapid, and accurate methodologies to detect myocardial ischemia are required in patients with acute coronary syndrome, 9,10) as adequate medical treatment or coronary revascularization can improve the prognosis. The present case highlights the use of ischemic QRS axis deviation tendency to indicate ischemic heart disease, including left main trunk disease.…”

Association of Fish Consumption-Derived Ratio of Serum n-3 to n-6 Polyunsaturated Fatty Acids and Cardiovascular Risk With the Prevalence of Coronary Artery Disease

“…Thus, we cannot arrive at any conclusion from this study, except to state that the prevalence of CAD is probably lower in populations with a high EPA/AA ratio. Third, because determination of the presence of CAD in this study population relied on the findings of coronary angiography, the existence of subjects in the study population of undetected cases of asymptomatic CAD which can be diagnosed primarily by an exercise stress test or non-invasive tests 31) such as coronary artery computed tomography cannot be ruled out. Fourth, because this study was a pilot cross-sectional single-center study involving a relatively small number of subjects and there were missing test data for 51 of the 700 consecutive cases, we cannot rule out the existence of case selection bias.…”