Relationship between the Deformation Properties of the Left Ventricle and the Severity of Coronary Atherosclerosis in Patients with Coronary Artery Disease

ORIGINAL ARTICLE
F. M. Bekmetova, Kh. G. Fozilov, Sh. N. Doniyorov, R. B. Alieva, M. G. Mukhamedova, L. T. I’lkhomova, Sh. U. Khoshimov, S. I. Bekmetova

 
International Journal of Biomedicine. 2021;11(2):131-136.
DOI: 10.21103/Article11(2)_OA1
Originally published June 5, 2021

Abstract: 

The purpose of this study was to assess the left ventricular myocardial deformation in patients with coronary artery disease (CAD) with various degrees of coronary lesions.
Methods and Results:The study included 74 patients with stable angina pectoris Class II-IV aged between 40 and 70 years. All patients underwent the following examinations: assessment of traditional risk factors, physical examination, general clinical and laboratory blood tests, 12-lead ECG, 24-hour ABPM, transthoracic echocardiography, two-dimensional speckle tracking echocardiography (STE), and coronary angiography (CAG). The SYNTAX score was calculated retrospectively according to the SYNTAX score algorithm. All patients were divided into 3 groups: Group 1 included 21 patients with a low SYNTAX score (0–22), for whom standard drug therapy was recommended; Group 2 included 28 patients with an intermediate SYNTAX score (23–32), to whom PCI was recommended; Group 3 included 25 patients with a high SYNTAX score (≥33), to whom CABG was recommended.
Left ventricular ejection fraction (LVEF) obtained using the modified biplane Simpson's method was significantly lower in Group 3 than in Groups 1 and 2 (P=0.001); it should be noted that this indicator was within the normative values in Groups 1 and 2, and belonged to the gradation “mild dysfunction.”
A more objective quantitative assessment of the contractile function of the LV myocardium was obtained by assessing the GLS and SR. The comparative analysis of the LV myocardial deformation properties in the three studied groups showed that in Group 3 the GLS and SR indicators were significantly lower than in Group 1 (P=0.000 and P=0.0020). Moreover, GLS (global longitudinal strain) and SR (strain rate) were significantly higher in Group 1 than in Group 2 (P=0.0001 and P=0.0133, respectively). GLS significantly correlated with LVEF (r=0.57; P<0.05), E/A (r=0.22; P<0.05), and SYNTAX score (r=-0.63; P<0.05). SR significantly correlated with LVEF (r=0.49; P<0.05) and SYNTAX score (r=-0.37; P<0.05)

Conclusion: The results obtained indicate the diagnostic value of STE with the determination of GLS and SR in a comprehensive assessment of the severity of SAD. GLS and SR significantly correlate with the clinical course of the disease, as well as indicators of LV remodeling and LV diastolic dysfunction. STE analysis of GLS and SR has incremental diagnostic value over transthoracic echocardiography in predicting significant CAD.

 

Keywords: 
coronary artery disease • speckle tracking echocardiography • global longitudinal strain
References: 
  1. Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S, Song JH, Hamilton J, Sengupta PP, Kolias TJ, d'Hooge J, Aurigemma GP, Thomas JD, Badano LP. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015 Jan;16(1):1-11. doi: 10.1093/ehjci/jeu184. 
  2.  Duncan AE, Alfirevic A, Sessler DI, Popovic ZB, Thomas JD. Perioperative assessment of myocardial deformation. Anesth Analg. 2014 Mar;118(3):525-44. doi: 10.1213/ANE.0000000000000088.
  3. Weidemann F, Jamal F, Sutherland GR, Claus P, Kowalski M, Hatle L, De Scheerder I, Bijnens B, Rademakers FE. Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate. Am J Physiol Heart Circ Physiol. 2002 Aug;283(2):H792-9. doi: 10.1152/ajpheart.00025.2002. 
  4. Truong VT, Phan HT, Pham KNP, Duong HNH, Ngo TNM, Palmer C, Nguyen TTH, Truong BH, Vo MA, Tretter JT, Nagueh SF, Chung ES, Mazur W. Normal Ranges of Left Ventricular Strain by Three-Dimensional Speckle-Tracking Echocardiography in Adults: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr. 2019 Dec;32(12):1586-1597.e5. doi: 10.1016/j.echo.2019.07.012
  5. Levy PT, Sanchez Mejia AA, Machefsky A, Fowler S, Holland MR, Singh GK. Normal ranges of right ventricular systolic and diastolic strain measures in children: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2014 May;27(5):549-60, e3. doi: 10.1016/j.echo.2014.01.015. 
  6. Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J. 2016 Apr 14;37(15):1196-207. doi: 10.1093/eurheartj/ehv529. 
  7. Adamo L, Perry A, Novak E, Makan M, Lindman BR, Mann DL. Abnormal Global Longitudinal Strain Predicts Future Deterioration of Left Ventricular Function in Heart Failure Patients With a Recovered Left Ventricular Ejection Fraction. Circ Heart Fail. 2017 Jun;10(6):e003788. doi: 10.1161/CIRCHEARTFAILURE.116.003788.
  8. Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging. 2009 Sep;2(5):356-64. doi: 10.1161/CIRCIMAGING.109.862334.
  9. Grenne B, Eek C, Sjøli B, Dahlslett T, Uchto M, Hol PK, Skulstad H, Smiseth OA, Edvardsen T, Brunvand H. Acute coronary occlusion in non-ST-elevation acute coronary syndrome: outcome and early identification by strain echocardiography. Heart. 2010 Oct;96(19):1550-6. doi: 10.1136/hrt.2009.188391. 
  10. Dahlslett T, Karlsen S, Grenne B, Eek C, Sjøli B, Skulstad H, Smiseth OA, Edvardsen T, Brunvand H. Early assessment of strain echocardiography can accurately exclude significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary syndrome. J Am Soc Echocardiogr. 2014 May;27(5):512-9. doi: 10.1016/j.echo.2014.01.019. 
  11. Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014 Nov;100(21):1673-80. doi: 10.1136/heartjnl-2014-305538. 
  12. Negishi T, Negishi K, Thavendiranathan P, Cho GY, Popescu BA, Vinereanu D, Kurosawa K, Penicka M, Marwick TH; SUCCOUR Investigators. Effect of Experience and Training on the Concordance and Precision of Strain Measurements. JACC Cardiovasc Imaging. 2017 May;10(5):518-522. doi: 10.1016/j.jcmg.2016.06.012. 
  13. Karlsen S, Dahlslett T, Grenne B, Sjøli B, Smiseth O, Edvardsen T, Brunvand H. Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training. Cardiovasc Ultrasound. 2019 Sep 2;17(1):18. doi: 10.1186/s12947-019-0168-9. 
  14. Lacalzada J, de la Rosa A, Izquierdo MM, Jiménez JJ, Iribarren JL, García-González MJ, López BM, Duque MA, Barragán A, Hernández C, Carrillo-Pérez M, Laynez I. Left ventricular global longitudinal systolic strain predicts adverse remodeling and subsequent cardiac events in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiovasc Imaging. 2015 Mar;31(3):575-84. doi: 10.1007/s10554-015-0593-2.
  15. Geyer H, Caracciolo G, Abe H, Wilansky S, Carerj S, Gentile F, Nesser HJ, Khandheria B, Narula J, Sengupta PP. Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr. 2010 Apr;23(4):351-69; quiz 453-5. doi: 10.1016/j.echo.2010.02.015. Erratum in: J Am Soc Echocardiogr. 2010 Jul;23(7):734. 
  16. Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, et al.; Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology; ESC Committee for Practice Guidelines (CPG). Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J. 2006 Jun;27(11):1341-81. doi: 10.1093/eurheartj/ehl001.
  17. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14.
  18. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation. 1975 Apr;51(4 Suppl):5-40. doi: 10.1161/01.cir.51.4.5. 
  19. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005 Aug;1(2):219-27. 
  20. Dalen H, Thorstensen A, Aase SA, Ingul CB, Torp H, Vatten LJ, Stoylen A. Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: the HUNT study in Norway. Eur J Echocardiogr. 2010 Mar;11(2):176-83. doi: 10.1093/ejechocard/jep194. 
  21. Kocabay G, Muraru D, Peluso D, Cucchini U, Mihaila S, Padayattil-Jose S, Gentian D, Iliceto S, Vinereanu D, Badano LP. Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values in healthy adults. Rev Esp Cardiol (Engl Ed). 2014 Aug;67(8):651-8. doi: 10.1016/j.rec.2013.12.009. 
  22. Kuznetsova T, Herbots L, Richart T, D'hooge J, Thijs L, Fagard RH, Herregods MC, Staessen JA. Left ventricular strain and strain rate in a general population. Eur Heart J. 2008 Aug;29(16):2014-23. doi: 10.1093/eurheartj/ehn280. 
  23. Smedsrud MK, Sarvari S, Haugaa KH, Gjesdal O, Ørn S, Aaberge L, Smiseth OA, Edvardsen T. Duration of myocardial early systolic lengthening predicts the presence of significant coronary artery disease. J Am Coll Cardiol. 2012 Sep 18;60(12):1086-93. doi: 10.1016/j.jacc.2012.06.022.
  24. Bochenek T, Wita K, Tabor Z, Grabka M, Krzych Ł, Wróbel W, Berger-Kucza A, Elżbieciak M, Doruchowska A, Gluza MT. Value of speckle-tracking echocardiography for prediction of left ventricular remodeling in patients with ST-elevation myocardial infarction treated by primary percutaneous intervention. J Am Soc Echocardiogr. 2011 Dec;24(12):1342-8. doi: 10.1016/j.echo.2011.09.003. 
  25. Cong T, Sun Y, Shang Z, Wang K, Su D, Zhong L, Zhang S, Yang Y. Prognostic Value of Speckle Tracking Echocardiography in Patients with ST-Elevation Myocardial Infarction Treated with Late Percutaneous Intervention. Echocardiography. 2015 Sep;32(9):1384-91. doi: 10.1111/echo.12864.
  26. D'Andrea A, Cocchia R, Caso P, Riegler L, Scarafile R, Salerno G, Golia E, Di Salvo G, Calabrò P, Bigazzi MC, Liccardo B, Esposito N, Cuomo S, Bossone E, Russo MG, Calabrò R. Global longitudinal speckle-tracking strain is predictive of left ventricular remodeling after coronary angioplasty in patients with recent non-ST elevation myocardial infarction. Int J Cardiol. 2011 Dec 1;153(2):185-91. doi: 10.1016/j.ijcard.2010.08.025. 
  27. Abdelrazek G, Yassin A, Elkhashab K. Correlation between global longitudinal strain and SYNTAX score in coronary artery disease evaluation. Egypt Heart J. 2020 May 15;72(1):22. doi: 10.1186/s43044-020-00064-2.
  28. Vrettos A, Dawson D, Grigoratos C, Nihoyannopoulos P. Correlation between global longitudinal peak systolic strain and coronary artery disease severity as assessed by the angiographically derived SYNTAX score. Echo Res Pract. 2016 Jun;3(2):29-34. doi: 10.1530/ERP-16-0005. 
  29. Benyounes N, Lang S, Soulat-Dufour L, Obadia M, Gout O, Chevalier G, Cohen A. Can global longitudinal strain predict reduced left ventricular ejection fraction in daily echocardiographic practice? Arch Cardiovasc Dis. 2015 Jan;108(1):50-6. doi: 10.1016/j.acvd.2014.08.003. 
  30. Lima MSM, Villarraga HR, Abduch MCD, Lima MF, Cruz CBBV, Sbano JCN, Voos MC, Mathias W Junior, Tsutsui JM. Global Longitudinal Strain or Left Ventricular Twist and Torsion? Which Correlates Best with Ejection Fraction? Arq Bras Cardiol. 2017 Jul;109(1):23-29. doi: 10.5935/abc.20170085.

Download Article
©2021 International Medical Research and Development Corporation.