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August 30, 2022Open Access

Coronary microvascular dysfunction affects left ventricular global longitudinal strain response to dipyridamole stress echocardiography: a pilot study

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Key result

Coronary microvascular dysfunction in patients with non-obstructive coronary artery disease was associated with a paradoxical worsening of global longitudinal strain during dipyridamole stress (from -16.8% to -15.8%) compared to an improvement in those with normal flow reserve.

Why the study?

To investigate, using speckle tracking echocardiography, left ventricular contractile function at rest and during dipyridamole stress in patients with coronary microvascular dysfunction.

Does coronary microvascular dysfunction affect left ventricular global longitudinal strain response during dipyridamole stress echocardiography in patients with non-obstructive coronary artery disease?

Population

59 patients with chest pain and without obstructive CAD

Comparison

Patients with CMD (CFR < 2) vs patients without CMD

Design

Pilot study

Authors

ETErcole TagliamontePoliclinico Umberto ISSSimona SperlonganoCardiac ImagingCMCaterina MontuoriIstituto Nazionale di Geofisica e Vulcanologia

Discussion

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Implication

Paradoxical GLS decrease during dipyridamole stress was associated with CMD; leaves open its diagnostic utility in non-obstructive CAD.

Key Points

  • To assess left ventricular contractile function at rest and during dipyridamole stress echocardiography using speckle tracking echocardiography in patients with coronary microvascular dysfunction.
  • Enrolled 59 patients (39% women, mean age 65.6 ± 6.1 years) with chest pain and non-obstructive coronary artery disease undergoing dipyridamole stress echocardiography.
  • Coronary flow reserve (CFR) was measured in the left anterior descending coronary artery, defining coronary microvascular dysfunction (CMD) as CFR < 2.
  • Left ventricular global longitudinal strain (GLS) was measured at rest and during peak dipyridamole stress.
  • Nineteen patients (32%) had CMD, presenting with significantly worse baseline GLS compared to controls (-16.8 ± 2.7% vs. -19.1 ± 3.1%, p < 0.01).
  • During peak dipyridamole stress, GLS worsened in the CMD group (from -16.8 ± 2.7% to -15.8 ± 2.7%, p < 0.01), whereas it improved in patients without CMD (from -19.1 ± 3.1% to -20.2 ± 3.1%, p < 0.01).
  • A strong inverse correlation occurred between coronary flow reserve and the change in global longitudinal strain (r = -0.82, p < 0.01).

Study Design

Type

Observational (n=59)

Blinding

Blinded analysis

Multicenter

No

Structured PICO

Does coronary microvascular dysfunction affect left ventricular global longitudinal strain response during dipyridamole stress echocardiography in patients with non-obstructive coronary artery disease?

P
Population
59 patients (mean age 65.6 years, 39% female) with a history of chest pain and non-obstructive coronary artery disease who underwent dipyridamole stress echocardiography.
E
Exposure
Dipyridamole stress echocardiography (0.84 mg/kg over 6 minutes) in patients with coronary microvascular dysfunction (CMD), defined as coronary flow reserve (CFR) < 2.
C
Comparator
Dipyridamole stress echocardiography in patients without coronary microvascular dysfunction (CFR ≥ 2).
O
Outcome
Left ventricular global longitudinal strain (GLS) measured by speckle tracking echocardiography at rest and at peak dipyridamole dose.surrogate

Main Result

Effect estimate: r = -0.82

Absolute Event Rate: 1.04% vs -1.18%

p-value: p=<0.001

Patients with coronary microvascular dysfunction and non-obstructive CAD exhibit impaired resting global longitudinal strain and a paradoxical decrease in contractile function during dipyridamole stress, indicating subclinical ischemia.

Limitations

  • Single-center study
  • Small sample size
  • single center
  • small sample size

Cite This Study

Tagliamonte et al. (2022) conducted an observational in Chest pain without obstructive coronary artery disease (n=59). Coronary microvascular dysfunction (CFR < 2) vs. Normal coronary flow reserve (CFR ≥ 2) was evaluated on Change in global longitudinal strain (ΔGLS) from rest to peak dipyridamole dose (r = -0.82, p=<0.001). Coronary microvascular dysfunction in patients with non-obstructive coronary artery disease was associated with a paradoxical worsening of global longitudinal strain during dipyridamole stress (from -16.8% to -15.8%) compared to an improvement in those with normal flow reserve.

synapsesocial.com/papers/6a9473a9fde2ed39e1a0d969https://doi.org/10.21203/rs.3.rs-1999574/v1
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Also Consider

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