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Unmasking latent cardiac dysfunction in angina with non-obstructive coronary artery disease (ANOCA) patients: An
Biniyam G Demissei1, Agostina A Sanchez1, Vaishnavi S Sawant2
1MedStar Health Research Institute, Washington, DC, United States of America.
Insights
This study reveals frequent cardiac abnormalities in patients with angina with non-obstructive coronary artery disease (ANOCA), identified through advanced echocardiography. These findings highlight the importance of detailed cardiac assessments in ANOCA patients.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Angina with non-obstructive coronary artery disease (ANOCA) involves complex mechanisms leading to myocardial injury.
- Echocardiographic assessment of left ventricular function in ANOCA patients is currently limited.
Purpose of the Study:
- To investigate cardiac abnormalities using echocardiographic myocardial deformation parameters in patients with ANOCA.
- To assess left ventricular function and diastolic parameters in ANOCA patients.
Main Methods:
- Utilized artificial intelligence-assisted quantitative echocardiography on 88 ANOCA patients from the Coronary Microvascular Disease Registry (CMDR).
- Evaluated FDA-approved parameters of left ventricular deformation, wall thickness, and diastolic function.
- Quantified left atrial (LA) reservoir strain manually.
Main Results:
- 47.6% of patients exhibited abnormal Global Longitudinal Strain (GLS).
- A significant proportion showed abnormal septal/lateral e' velocity and elevated E/e' ratios, indicating diastolic dysfunction.
- 60% of patients had abnormal LA reservoir strain, with some showing signs of significant diastolic impairment.
Conclusions:
- Echocardiographic myocardial deformation parameters reveal a high prevalence of cardiac abnormalities in ANOCA patients.
- These findings underscore the utility of advanced echocardiography in characterizing cardiac dysfunction in ANOCA.
Background:
The pathophysiologic mechanisms underlying angina with non-obstructive coronary artery disease (ANOCA) are multifactorial, leading to myocardial injury and adverse cardiovascular events. The echocardiographic phenotyping of left ventricular function in patients with ANOCA is sparse.
Methods:
Of the 362 patients enrolled in the Coronary Microvascular Disease Registry (CMDR), eighty-eight ANOCA patients with available transthoracic echocardiograms were included in this cross-sectional study, after excluding patients with poor image quality and those with LVEF ≤40 %. Artificial intelligence-assisted quantitative echocardiography analysis, with additional meticulous tracking inspection as necessary, was performed using the Us2.v2 platform. FDA-approved/cleared parameters of left ventricular deformation, wall thickness, and diastolic function were evaluated. Left atrial (LA) reservoir strain was quantified manually by an experienced echocardiographer.
Results:
The mean age was 60 years (SD: 12), 72.7 % were female, and 65.5 % were Black. The mean LVEF was 60.4 % (SD: 6.5); 81.2 % of the patients had LVEF>55 %. Global longitudinal strain (GLS) was abnormal, as defined by GLS < 18 %, in 47.6 % of the patients. The majority (56 % to 70 %) had abnormal septal e' velocity (<7 cm/s), lateral e' velocity (<10 cm/s), and abnormal/borderline E/e' (≥8). LA reservoir strain was abnormal (<39 %) in 60 % of the patients. The proportion of patients with peak tricuspid regurgitation velocity > 2.8 m/s and LA volume index >34 mL/m2, suggesting significant diastolic impairment, was 10.4 % and 7.9 %. Abnormal interventricular septum and posterior wall diameters (>1.1 cm) were observed in 32.9 % and 23.5 %, respectively.
Conclusion:
Our findings demonstrate a high prevalence of cardiac abnormalities, utilizing echocardiographic myocardial deformation parameters in patients with ANOCA.
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