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Evaluation of left ventricular flow field changes after stress in patients with nonobstructive coronary artery
Dongmei Li1, Xin Zhao2, Qiuyu Xiao1
1School of Medicine, University of Electronic Science and Technology, Chengdu, China.
Insights
Vector flow mapping revealed altered left ventricular (LV) blood flow in patients with nonobstructive coronary artery disease. Increased D1 vortex area post-stress is a risk factor for mild coronary stenosis, aiding early detection.
Area of Science:
- Cardiovascular Imaging
- Hemodynamics
- Echocardiography
Background:
- Nonobstructive coronary artery disease (CAD) affects left ventricular (LV) function.
- Assessing subtle hemodynamic changes in nonobstructive CAD is crucial for early diagnosis.
- Vector flow mapping (VFM) and stress echocardiography offer advanced insights into LV hemodynamics.
Purpose of the Study:
- To evaluate changes in the left ventricular (LV) flow field using VFM and treadmill stress echocardiography in patients with nonobstructive CAD.
- To identify hemodynamic markers associated with nonobstructive coronary artery stenosis.
Main Methods:
- Compared 34 patients with nonobstructive CAD to 36 controls.
- Acquired echocardiographic images at rest and post-treadmill exercise.
- Analyzed LV flow field, vortex area, and circulation in different cardiac phases (S1-S3, D1-D4).
Main Results:
- Patients with nonobstructive CAD showed irregular LV streamline distributions and abnormal vortices at rest.
- Post-stress, both groups exhibited more disordered LV blood flow.
- Increased D1 vortex area after stress independently predicted nonobstructive coronary artery stenosis (OR: 1.007, P<0.05).
Conclusions:
- Resting LV flow patterns are altered in nonobstructive CAD.
- Post-stress LV flow becomes more disordered in both patients and controls.
- Increased D1 vortex area post-stress is a valuable indicator for assessing nonobstructive coronary artery stenosis, aiding early CAD evaluation.
Purpose:
Vector flow mapping and treadmill exercise stress echocardiography were used to evaluate and explore changes in the left ventricular (LV) flow field of patients with nonobstructive coronary artery disease.
Methods:
Overall, 34 patients with nonobstructive (<50%) left anterior descending coronary artery stenosis (case group) and 36 patients with no coronary artery stenosis (control group) were included. Apical four-, three-, and two-chamber echocardiographic images were collected at rest and during early recovery from treadmill exercise. LV flow field, vortex area, and circulation (cir) changes were recorded in different phases: isovolumetric systole (S1), rapid ejection (S2), slow ejection (S3), isovolumetric diastole (D1), rapid filling (D2), slow filling (D3), and atrial systole (D4). Intra- and inter-group differences were compared before and after exercise loading.
Results:
The control and case groups demonstrated regular trends of eddy current formation and dissipation at rest and under stress. Compared with the control group, the case group had irregular streamline distributions. Abnormal vortices formed in the S1 and D3 apical segments and D1 left ventricular middle segment in the resting group. Compared with the control group, the resting group had decreased left ventricular S1 vortex areas and increased S3 vortex areas. The post-stress D1 and D3 vortex areas and D1 and D2 cir increased. Compared with at rest, after stress, the control group had decreased S1, S3, D2, and D3 vortex areas; increased S2, D1, D3, and D4 cir; and decreased D2 cir. After stress, the case group had decreased S3 and D2 vortex areas, increased D1 vortex areas, and increased S2, D1, D3, and D4 cir (P all < 0.001). Logistic regression and ROC curve analyses show that increased D1 vortex area after stress is an independent risk factor for stenosis in nonobstructive stenosis of coronary arteries (OR: 1.007, 95% CI: 1.005-1.010, P < 0.05). A D1 vortex area cutoff value of 82.26 had an AUC, sensitivity, and specificity of 0.67, 0.655, and 0.726, respectively.
Conclusion:
The resting left ventricular flow field changed in patients with nonobstructive left anterior descending coronary artery stenosis. Both groups had more disordered left ventricular blood flow after stress. The increased D1 vortex area after stress is an independent risk factor for mild coronary stenosis and may contribute to the assessment of nonobstructive coronary stenosis. VFM combined with treadmill stress is useful in evaluating left ventricular flow field changes in patients with nonobstructive coronary artery disease, which is valuable in the early evaluation of coronary heart disease.
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