Key result
In patients with INOCA, coronary microvascular dysfunction (abnormal CFVR) was accompanied by impaired global longitudinal strain (p<0.007) and higher mechanical dispersion (p<0.0005) during stress.
Why the study?
In patients with INOCA, wall motion is rarely abnormal during stress echocardiography, prompting evaluation of whether those with reduced coronary flow velocity reserve have altered cardiac mechanics on two-dimensional speckle-tracking echocardiography.
Does coronary microvascular dysfunction (abnormal CFVR) alter cardiac mechanics measured by 2DSTE during dipyridamole stress echocardiography in patients with INOCA?
Observational (n=130)
Yes
Does coronary microvascular dysfunction (abnormal CFVR) alter cardiac mechanics measured by 2DSTE during dipyridamole stress echocardiography in patients with INOCA?
p-value: p=<0.007
Vasodilator stress echocardiography with simultaneous assessment of CFVR and strain is highly feasible and detects impaired deformation indices in INOCA patients with coronary microvascular dysfunction.
Supports simultaneous CFVR-strain assessment during stress echo in INOCA; hypothesis-generating for microvascular effects on deformation.
Background: In patients with Ischemia and non-obstructive coronary artery stenosis (INOCA) wall motion is rarely abnormal during stress echocardiography (SE). Our aim was to determine if patients with INOCA and reduced coronary flow velocity reserve (CVFR) have altered cardiac mechanics using two-dimensional speckle-tracking echocardiography (2DSTE) during SE. Methods: In a prospective, multicenter, international study, we recruited 135 patients with INOCA. Overall, we performed high dose (0.84 mg/kg) dipyridamole SE with combined assessment of CVFR and 2DSTE. The population was divided in patients with normal CVFR (>2, group 1, n = 95) and abnormal CVFR (≤2, group 2, n = 35). Clinical and 2DSTE parameters were compared between groups. Results: Feasibility was high for CFVR (98%) and 2DSTE (97%). A total of 130 patients (mean age 63 ± 12 years, 67 women) had complete flow and strain data. The two groups showed similar 2DSTE values at rest. At peak SE, Group 1 patients showed lower global longitudinal strain (p < 0.007), higher mechanical dispersion (p < 0.0005), lower endocardial (p < 0.001), and epicardial (p < 0.0002) layer specific strain. Conclusions: In patients with INOCA, vasodilator SE with simultaneous assessment of CFVR and strain is highly feasible. Coronary microvascular dysfunction is accompanied by an impairment of global and layer-specific deformation indices during stress.
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Rodríguez‐Zanella et al. (2022) conducted an observational in Ischemia and non-obstructive coronary artery stenosis (INOCA) (n=130). Abnormal coronary flow velocity reserve (CFVR ≤2) vs. Normal CFVR (>2) was evaluated on Global longitudinal strain at peak stress echocardiography (p=<0.007). In patients with INOCA, coronary microvascular dysfunction (abnormal CFVR) was accompanied by impaired global longitudinal strain (p<0.007) and higher mechanical dispersion (p<0.0005) during stress.
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