Key result
Coronary artery disease was associated with significantly decreased left and right atrial systolic strain and strain rate compared to normal coronaries, despite normal atrial volumes.
Why the study?
Does coronary artery disease severity correlate with reduced left and right atrial strain and strain rate in patients with stable angina?
Case-Control (n=40)
No
Does coronary artery disease severity correlate with reduced left and right atrial strain and strain rate in patients with stable angina?
p-value: p=0.001
In patients with stable CAD, left and right atrial systolic strain and strain rate are reduced early in the disease process, before changes in atrial volumes or distensibility occur.
May detect early atrial dysfunction in stable CAD before volume changes; leaves open prospective validation for risk stratification.
In patients with coronary artery disease (CAD), there are several studies that assessed the left ventricular (LV) function by strain (S) and strain rate (SR) imaging. The aim of this study is to evaluate the function of both atria in patients with CAD using strain and strain rate imaging, and to correlate this with the severity of CAD. We conducted a prospective, single center case control study for 40 consecutive patients who presented to our department with chronic stable angina and were candidates for invasive coronary angiography. We enrolled patients from December 2013 to May 2014 and each patient was subjected to echocardiographic assessment of E/e′ of mitral valve, left atrial volume index (LAVI), right atrial volume index (RAVI), and peak atrial longitudinal strain (es) and strain rate (SR) during LV systole. This was followed by invasive coronary angiography for assessment of the severity of CAD using Gensini score. Patients were classified according to angiographic results into 3 groups: Group I (Gensini score = zero), Group II (Gensini score > 0 and < 20) and Group III (Gensini score ≥ 20). There was no statistically significant difference between the three groups in either LA volumes (Vmin, Vmax) and distensibility with p value of 0.272, 0.126, and 0.243 respectively or RA volumes and distensibility with a p value of 0.671, 0.183, and 0.259 respectively. On the other hand, LA & RA systolic S and SR were significantly lower among CAD patients in comparison with the group of normal coronaries. Mean LA S and SR was decreased in group III than group II (15.97 ± 3.73, 21.8 ± 6.75 % and 1.11 ± 0.30, 1.81 ± 1.23 s−1) with p value of 0.005&0.041 respectively. RA systolic S and SR were significantly lower in the 2 groups with CAD than the group with normal coronaries with a p value of 0.001 and 0.002 respectively. In patients with CAD and normal EF, borderline E/e′ ratio and normal atrial size, there are decreased LA and RA systolic S and SR parameters with no effect on atrial volumes or distensibility. Accordingly, this could prove that atrial wall deformation occurs early in CAD even before any changes in atrial volumes or dimensions.
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Khedr et al. (2018) conducted a case-control in Stable coronary artery disease (n=40). Coronary artery disease vs. Normal coronaries (Gensini score = 0) was evaluated on Left and right atrial systolic strain and strain rate (p=0.001). Coronary artery disease was associated with significantly decreased left and right atrial systolic strain and strain rate compared to normal coronaries, despite normal atrial volumes.
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