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Subtle echocardiographic markers of CAD: looking beyond the LV ejection fraction in stable angina patients
Harshit Khare1, Satyendra Tewari2, Ankit Sahu2
1Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. harshit.sgpgi@gmail.com.
Insights
Echocardiograms can detect subtle coronary artery disease (CAD) markers beyond standard assessments. Left atrial strain and filling pressures show significant correlation with CAD severity, improving diagnostic accuracy.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Biomarkers
Background:
- Routine echocardiograms primarily detect regional wall motion abnormality (RWMA) and left ventricle diastolic dysfunction (LVDD) for coronary artery disease (CAD).
- Absence of these markers often leads to a "normal" study, highlighting a need for subtle CAD indicators.
- This study addresses the unmet need for enhanced echocardiographic markers in diagnosing CAD.
Purpose of the Study:
- To identify and evaluate subtle echocardiographic markers of CAD in patients with stable angina.
- To assess the correlation between left ventricle (LV) and left atrium (LA) strain parameters and the SYNTAX score-II (SS-II).
Main Methods:
- Echocardiography was used to assess LV systolic and diastolic parameters, and LA strain parameters in 103 stable angina patients.
- These parameters were compared with coronary angiography-derived SYNTAX score-II (SS-II).
Main Results:
- Left ventricle global longitudinal strain (LV-GLS) and LA Volume indexed (LAVi) did not significantly correlate with SS-II.
- Left atrial filling pressures (E/e`) increased significantly with SS-II (cut-off >10.39 for significant CAD).
- LA reservoir function (PALS < 23.56, LAsSR < 1.15) and conduit function (LAeSR > 1.09) parameters showed significant association with CAD severity.
Conclusions:
- Left atrial strain and diastolic parameters are potential echocardiographic markers for CAD in stable angina.
- These parameters, alongside RWMA and LV-GLS, can improve the diagnostic yield of echocardiography for CAD.
- Echocardiography can offer a more comprehensive assessment of CAD beyond traditional markers.
Background:
A routine echocardiogram aims at identifying only regional wall motion abnormality (RWMA) or left ventricle diastolic dysfunction (LVDD) for coronary artery disease (CAD). When absent, a study is often labeled "normal." This creates an unmet need to identify and add subtle markers of CAD to the routine echocardiogram to increase the diagnostic yield.
Methods:
Left ventricle (LV) systolic and diastolic parameters, along with left atrium (LA) strain parameters, were assessed using echocardiography in one hundred three patients of stable angina undergoing coronary angiography and compared with their SYNTAX score-II (SS-II).
Results:
The left ventricle global longitudinal strain (LV-GLS) and LA Volume indexed (LAVi) did not correlate significantly with the SS-II. The LA filling pressures reflected by the ratio of early mitral inflow velocity with early mitral annular velocity (E/e`), however, increased significantly with SS-II, with a cut-off value >10.39 for significant CAD (pvalue <0.001). The LA reservoir function parameters, peak atrial longitudinal strain (PALS), and peak global systolic strain rate (LAsSR) decreased significantly with increasing SS-II (p values of 0.011 and 0.001, respectively). The values < 23.56 for PALS and less than 1.15 for LAsSR, showed a significant association with CAD. The LA conduit function parameter, peak global early diastolic strain rate (LAeSR), also increased significantly with increasing SS-II (p-value <0.001), with values > 1.09 having a good correlation with CAD.
Conclusion:
Besides RWMA and LV-GLS, the LV diastolic and LA strain parameters can be potential echocardiographic markers for CAD in stable angina patients.
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