The relationship between mechanical dyssynchrony of the left ventricular myocardium and the number of affected coronary arteries in patients with coronary heart disease who underwent revascularization

Abstract

Background. A promising method for early detection of myocardial dysfunction is the evaluation of mechanical dyssynchrony of the left ventricular myocardium, the prognostic value of which in the diagnosis of 3-vessel lesions was shown only in a single study and requires further confirmation. Purpose – to assess the relationship between the number of affected coronary arteries and the presence of mechanical dyssynchrony of the myocardium, and its significance in predicting 3-vessel lesions in patients with coronary heart disease. Materials and Methods. 134 patients who underwent coronary angiography with revascularization of coronary arteries were included in the study. Patients were divided into comparison groups depending on the number of affected coronary arteries (without lesions, one, two and three coronary arteries). Variables of mechanical myocardial dyssynchrony were determined for all patients by ultrasound examination of the heart using Doppler examination and synchronization with the ECG. Results. The largest relative number of patients with myocardial dyssynchrony was observed in the group with lesions of 3 coronary arteries – 23 (52%). The presence of myocardial dyssynchrony had a significant correlation with SYNTAX SCORE (r=0.18, p=0.035). The aortic pre-ejection interval in the group of patients with lesions of 3 coronary arteries was significantly longer compared to the group of patients without lesions of the coronary arteries, however, the pulmonary pre-ejection interval was the same in the comparison groups. As a result of this difference, interventricular mechanical delay was significantly greater in the group of patients with occlusion of 3 coronary arteries (54,8±36,6 ms; р=0,043). The time to peak systolic velocity in the group of patients with lesions of 3 coronary arteries was significantly longer (32,1±8,0 ms; р=0,021) compared to the group of patients without atherosclerotic lesions, which was confirmed by a positive correlation (r=0.190, p=0.003). The ROC analysis of the predictive capabilities of the combination of the factors of the presence of myocardial dyssynchrony, left ventricular ejection fraction, interventricular mechanical delay, root mean square deviation of the time to the peak of systolic velocity, and the E/A ratio in relation to lesions of 3 coronary arteries showed sufficient sensitivity (0.89) and specificity (0.87). Conclusions. Patients with lesions to 3 coronary arteries have a significantly higher relative frequency of mechanical myocardial dyssynchrony compared to patients without and lesions of 1 or 2 coronary arteries; correlation of myocardial dyssynchrony with 3-vessel lesions and SYNTAX SCORE was also found. The combination of variables of myocardial dyssynchrony in terms of predicting 3-vessel occlusion of coronary arteries has sufficient sensitivity and specificity.