The Relationship Between Coronary Artery Tortuosity and Myocardial Performance Evaluated by 2D Speckle-Tracking Echocardiography

Background: Coronary artery tortuosity (CAT) as a common angiographic finding, while its effect on myocardial performance remains not fully understood. The current research aimed to assess the relation between CAT and myocardial function evaluated by two-dimensional speckle-tracking echocardiography (2DSTE). Methods: We included 50 participants who underwent coronary angiography in this case-control research, they who were categorized into 2 groups: Group I comprised 25 patients without CAT, while Group II included cases with CAT. Conventional transthoracic echocardiography and 2DSTE were performed to assess cardiac structure, diastolic function, as well as global longitudinal strain (GLS). Results: Patients with CAT had significantly higher septal wall thickness (P=0.013), posterior wall thickness (P=0.029), left atrial diameter (P=0.029), left ventricular mass (P=0.040), and E/e′ ratio (9.63±2.55 vs. 7.96±1.47, P=0.007), along with lower septal e′ (P=0.023) and lateral e′ velocities (P=0.037). GLS was significantly impaired among CAT group than controls (-18.6±1.26% vs. -20.2±1.55%, P<0.001). Moreover, increasing CAT severity was associated with progressively worsening GLS (-19.3±0.91%, -18.3±0.71%, and -16.3±0.58% among mild, moderate, as well as severe CAT, respectively; P<0.001) and higher E/e′ ratios (7.8±1.05, 11.1±1.06, and 14.2±1.50, respectively; P<0.001). Conclusion: Coronary artery tortuosity is linked to subclinical myocardial dysfunction despite preserved left ventricular ejection fraction. CAT patients exhibited structural remodeling, impaired diastolic function, and reduced myocardial deformation, with dysfunction becoming more pronounced as tortuosity severity increases. Two-dimensional speckle-tracking echocardiography may provide incremental value for early detection of subclinical systolic impairment among patients with CAT