Subclinical left ventricular myocardial dysfunction in non-obstructive coronary artery disease

Abstract

Faculty of MedicineIn the second study, 96 patients (51 ± 8.6 years, 56% male) without significant CAD, hypertension and diabetes were enrolled prospectively. The exclusion of patients with hypertension and diabetes eliminate other known confounders of LV strains. LV strains were evaluated by 2D and 3D STE.Multivariable analyses were performed to investigate independent determinants of 2D and 3D multidirectional strains in each study. Additional analyses were performed to compare the predictive value of 2D versus 3D GLS for the presence of coronary atherosclerosis. ResultsIn the first study, EAT volume measured by cardiac computed tomography (CT) was independently associated with 3D global longitudinal strain (GLS, r = 0.601; p < 0.001), global circumferential strain (GCS, r = 0.375; p < 0.001), global radial strain (GRS, r = −0.546; p < 0.001), and global area strain (GAS, r = 0.558; p < 0.001). In multivariable analyses, EAT volume was the strongest predictor of 3D GLS (standardized β = 0.512; p < 0.001), GCS (standardized β = 0.242; p = 0.006), GRS (standardized β = −0.422; p < 0.001), and GAS (standardized β = 0.428; p < 0.001). In contrast, other measures of obesity including BMI and waist/hip ratio were not independent determinants of 3D multidirectional global strain (all p > 0.05).In the second study, patients with non-obstructive CAD had lower 2D GLS (-18.5 ± 2.2% vs. -20.1 ± 1.9%, p < 0.001) and 3D GLS (-14.9 ± 2.4% vs. -16.3 ± 3.1%, p = 0.011) compared to those without any coronary atherosclerosis. In multivariable analyses model using 2D GLS, both age (odd ratio = 2.16, p = 0.011) and 2D GLS (odd ratio = 1.55, p = 0.001) were independent determinants of non-obstructive coronary atherosclerosis. When 2D GLS was replaced with 3D GLS in similar analyses, both age (odd ratio = 2.23, p = 0.007) and 3D GLS (odd ratio =1.21, p = 0.027) were also independent determinants of coronary PUBLICATIONS INCLUDED IN THIS THESIS1. Ng AC, Goo SY, Roche N, van der Geest RJ, Wang WY.