Role of Strain-Derived Echocardiography Modality in Risk Stratification of High-Risk-Feature Chronic Coronary...

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Interventional Cardiology

Background:

• Chronic coronary syndrome (CCS) can present with diverse electrocardiographic (ECG) patterns.
• Wellens syndrome type B, characterized by specific T-wave inversions, suggests critical proximal left anterior descending (LAD) artery stenosis.
• Assessing regional myocardial function beyond ejection fraction is crucial for understanding ischemic heart disease.

Observation:

• Two patients with CCS and type B Wellens ECG findings had preserved left ventricular ejection fraction (LVEF) on echocardiography.
• Advanced myocardial function analysis revealed reduced left ventricular global longitudinal strain (LVGLS) and myocardial work index (MWI) in the LAD territory.
• Invasive coronary angiography confirmed significant proximal LAD stenosis in both individuals.

Findings:

• Percutaneous coronary intervention (PCI) with stent placement successfully restored TIMI flow grade III in the LAD.
• Post-revascularization follow-up demonstrated significant improvement in both LVGLS and MWI.
• These functional parameters correlated with successful revascularization and clinical improvement.

Implications:

• LVGLS and MWI are sensitive markers for detecting regional myocardial dysfunction in LAD stenosis.
• These advanced echocardiographic parameters can aid in risk stratification and monitoring treatment response in CCS.
• Revascularization of significant LAD stenosis, even in the presence of preserved LVEF, leads to functional myocardial recovery.