Prediction of coronary artery stenosis at rest in patients with normal left ventricular wall motion. Segmental...

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Techniques

Background:

• Noninvasive detection of coronary artery stenosis typically requires stress testing for patients without left ventricular (LV) regional wall motion abnormalities (RWMA).
• Ischemia-induced abnormal regional LV relaxation can persist even after transient ischemia resolves.
• This persistence offers a potential window for noninvasive detection without stress.

Purpose of the Study:

• To evaluate if segmental analysis of abnormal regional LV relaxation, using the strain imaging diastolic index (SI-DI) at rest, can predict significant coronary artery stenosis in the three major coronary arteries.
• To assess this predictive capability in patients specifically without LV dysfunction or RWMA.

Main Methods:

• 2D speckle tracking echocardiography and coronary angiography were performed in 85 patients with suspected coronary artery disease but no RWMA.
• LV images were acquired in apical views and divided into 6 segments.
• SI-DI was determined for each segment from transverse strain imaging; patients with LV dysfunction or acute coronary syndrome were excluded.

Main Results:

• 48 patients had significant coronary artery stenosis (≥70%).
• Optimal SI-DI cutoff values accurately predicted stenosis in major vessels: mid anteroseptal segment (60.5%) for LAD artery (83.3% sensitivity, 81.1% specificity), basal anterolateral segment (60.5%) for LCx artery (80.9% sensitivity, 90.3% specificity), and basal inferior segment (61.5%) for RCA artery (74.1% sensitivity, 77.8% specificity).

Conclusions:

• Segmental analysis of SI-DI at rest effectively predicts coronary artery stenosis in the three major vessels among patients without RWMA.
• This noninvasive echocardiographic approach shows promise for detecting coronary artery stenosis without the need for stress testing.