Prediction of coronary artery stenosis using strain imaging diastolic index at rest in patients with preserved
Koichi Kimura1, Katsu Takenaka, XiaoFang Pan
1Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. kimurak-int@h.u-tokyo.ac.jp
Insights
Strain imaging diastolic index (SI-DI) can identify coronary artery stenosis in patients with preserved ejection fraction (EF). This non-invasive echocardiography method aids in screening for coronary artery disease without stress testing.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Post-ischemic myocardial diastolic stunning is a prolonged condition after transient ischemia, even when systolic function recovers.
- Identifying coronary artery stenosis in clinical settings remains crucial for patient management.
- Resting strain imaging diastolic index (SI-DI) is explored as a potential diagnostic tool.
Purpose of the Study:
- To evaluate the efficacy of SI-DI at rest in detecting coronary artery stenosis in patients with suspected coronary artery disease and preserved ejection fraction (EF).
- To determine if SI-DI can serve as a non-invasive marker for coronary stenosis, reducing the need for stress provocation.
Main Methods:
- Retrospective analysis of 85 patients with suspected coronary artery disease and EF >50% who underwent echocardiography and coronary angiography.
- Speckle tracking strain analysis was performed on left ventricular (LV) segments from multiple views.
- LV segments were categorized into no stenosis (≤50%), mild stenosis (51-75%), and severe stenosis (>75%) based on coronary angiogram findings.
Main Results:
- SI-DI significantly decreased in segments with severe stenosis (p<0.05).
- Transverse SI-DI demonstrated high predictive value for severe stenosis (Area Under Curve = 0.80).
- A cut-off value of 49 for transverse SI-DI achieved 79% sensitivity and 73% specificity for severe stenosis.
Conclusions:
- Resting SI-DI is a novel and effective marker for predicting coronary stenosis, particularly in patients with preserved EF.
- SI-DI can be integrated into routine echocardiography for screening patients with suspected coronary artery disease.
- This method offers a non-invasive alternative that does not require stress provocation.
Background:
Post-ischemic myocardial diastolic stunning persists for a long time after transient ischemia even after systolic function has recovered. We sought to identify coronary artery stenosis in clinical patients using strain imaging diastolic index (SI-DI) at rest.
Methods:
We retrospectively examined 85 patients with suspected coronary artery disease and preserved ejection fraction (EF; >50%) who underwent both echocardiography and coronary angiography. Speckle tracking strains were measured in 3 apical views and parasternal left ventricular (LV) short-axis views at the papillary muscle level. LV segments with inadequate image quality and deficit segments in the movie were excluded by the blinded observer. After strain analysis, LV segments were classified into no stenosis (≤ 50%), mild stenosis (51-75%), and severe stenosis (>75%) groups on the bases of the coronary angiogram.
Results:
SI-DI decreased significantly in severe stenosis segments (p<0.05, ANOVA), but none of the peak strains showed significant difference. The area under the curve for predicting severe stenosis in radial, longitudinal, and transverse SI-DI was 0.72, 0.74, and 0.80, respectively. A cut-off value of 49 for transverse SI-DI can predict LV segments with severe stenosis with sensitivity of 0.79 and specificity of 0.73. A screening cut-off value of 63 for transverse SI-DI shows sensitivity of 0.95 and specificity of 0.50.
Conclusion:
SI-DI at rest is a novel marker in predicting coronary stenosis even in patients with preserved EF. This index can be used to screen patients with suspected coronary artery disease in routine echocardiography and does not require stress provocation.
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