Resting segmental speckle tracking strain and strain rate in stable coronary artery disease and revascularized
Hatice Akay Caglayan1,2, Didrik Kjønås3,4, Mikhail Kornev3,5
1Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway. hatice.akay.caglayan@unn.no.
Insights
Segmental strain and strain rate (S/SR) analysis reveals differences in patients with coronary artery disease (CAD). Peak early diastolic strain rate (SRe) is key for detecting subtle disparities in stable CAD patients undergoing percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Mechanics
Background:
- Acute coronary artery disease (CAD) is known to impair global and regional myocardial strain and strain rate (S/SR).
- Limited data exists on segmental S/SR in stable CAD patients, necessitating further investigation.
- Understanding segmental S/SR variations can aid in diagnosing and managing chronic chest pain patients.
Purpose of the Study:
- To investigate differences in resting segmental S/SR measurements in patients with normal coronary arteries versus stenotic coronary arteries.
- To compare these measurements with those in patients who have undergone revascularization for myocardial infarction (MI).
- To identify specific S/SR parameters that can differentiate between patient groups with varying CAD statuses.
Main Methods:
- Prospective enrollment of 510 patients with chronic chest pain and 102 revascularized MI patients.
- Transthoracic echocardiography with S/SR analysis, including global longitudinal strain (GLS), segmental peak longitudinal strain (PLS), peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), and post-systolic shortening (PSS).
- Coronary computed tomography angiography (CCTA) and invasive coronary angiography (CAG) were used for CAD assessment.
Main Results:
- Significant disparities in average segmental S/SR metrics were found between No-CAD and MI groups.
- Peak early diastolic strain rate (SRe) was the only metric significantly differing between No-CAD and percutaneous coronary intervention (PCI) groups.
- Differences in SRe, PLS, and GLS were observed between No-CAD and coronary artery bypass grafting (CABG) groups, with segmental SRe below 1.5 s⁻¹ showing the most marked difference among all groups.
Conclusions:
- Revascularized MI patients and those referred for CABG exhibit diminished segmental S/SR values.
- Among patients with chronic chest pain, segmental SRe is the most sensitive metric for detecting subtle disparities between No-CAD and PCI groups.
- Further research is warranted to explore the diagnostic accuracy of SRe in identifying subtle CAD-related myocardial dysfunction.
Abstract:
Patients with acute coronary artery disease (CAD) exhibit reduced global and regional strain and strain rate (S/SR). However, knowledge about segmental S/SR in stable CAD patients is still limited. This study aimed to investigate whether resting segmental S/SR measurements differ in patients with chronic chest pain who have normal coronary arteries or stenotic coronary arteries, and to compare these measurements to those in patients with revascularized myocardial infarction (MI). We prospectively enrolled 510 patients with chronic chest pain referred for coronary computed tomography angiography (CCTA) and 102 patients revascularized after MI. All participants underwent transthoracic echocardiography featuring S/SR analysis. In addition to the patients with MI, patients with suspected CAD based on CCTA findings subsequently underwent invasive coronary angiography (CAG). We assessed global longitudinal strain (GLS) and averaged segmental peak longitudinal strain during systole (PLS), peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), and post systolic shortening (PSS). We also determined functionally reduced segment percentages using differing S/SR cut-off values. There were significant disparities in all average segmental S/SR metrics between the No-CAD and MI groups. SRe was the only S/SR metric that differed significantly between the No-CAD and PCI groups. Differences in SRe, PLS and GLS measurements were observed between the No-CAD and CABG groups. The proportion of diminished segmental S/SR mirrored these findings. For the percentage of pathological segments with varying cut-off values, segmental SRe below 1.5 s- 1 displayed the most marked difference among the four groups (p < 0.001). Revascularized MI patients or those referred to CABG present with diminished segmental S/SR values. However, among patients with chronic chest pain, only segmental SRe discerns subtle disparities between the No-CAD and the PCI group. The diagnostic accuracy of SRe warrants further exploration in subsequent studies.
