Three-Dimensional Strain in Patients with Left Main Disease versus Non-left Main Disease in Stable Ischemic Heart Disease with Good Left Ventricular Function and No Regional Wall Motion Abnormality

Background: Noninvasive detection of coronary artery disease (CAD) in left main (LM) disease or three-vessel CAD usually requires a stress test since regional wall motion abnormalities (RWMAs) are not always obvious at rest. Strain is a more sensitive parameter of myocardial systolic function and may be abnormal in patients with severe CAD. Although there are studies on the detection of CAD using strain echo for single-, double-, and triple-vessel disease, LM disease has not been studied to the same extent. Aim and Objective: The objective of the study was to obtain the three-dimensional (3D) strain of patients of CAD with LM Vessel Disease versus Non-LM disease in stable ischemic heart disease (SIHD) with good left ventricular (LV) function and no RWMA and to correlate the 3D strain for any specific pattern. Methods: This is a cross-sectional study conducted in the Department of Cardiology, Government Medical College, Kozhikode, from January 2024 to December 2024, among patients aged >18 years with SIHD. Around 700 SIHD patients were screened; of these, 76 were enrolled in the study, underwent coronary angiography, and were divided into two groups: LM disease versus non-LM disease. 3D strain Echo was performed in both groups, and the results in CAD with LM disease versus non-LM disease were compared for any specific 3D strain pattern. Results: Among the 76 enrolled patients, the majority were male, aged 51–60 years. The most common presenting symptom was effort angina, and comorbidities were systemic hypertension, followed by diabetes mellitus. The mean Global strain of both LM and Non-LM groups was grossly reduced. The mean 3D global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) of the LM group versus the Non-LM group were −12.6 versus − 13.8, −13.2 versus − 13.0, −22.0 versus −22.7, and + 35.2 versus + 34.1, respectively. Conclusion: Patients with SIHD with no RWMA and good LV function have definite reductions in 3D strain in terms of GLS, GCS, GAS, and GRS in both LM and non-LM groups. The segmental analysis of GLS could not differentiate any specific strain pattern between them.