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Q: What does this research mean for the field?

Echocardiographic stress and strain parameters, particularly global longitudinal strain and regional elastic modulus, can non-invasively identify patients with significant coronary artery disease requiring percutaneous coronary intervention. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 12, 2020Open Access

Echocardiographic Assessment of the Left Ventricular Physical Parameters: A Comparison Study in Patients With Significant and Non-Significant Coronary Artery Disease

ZAZeinab Alsadat AhmadiRadboud University Nijmegen MMManijhe Mokhtari‐DizajiTarbiat Modares University ASAnita SadeghpourMedStar Washington Hospital Center

Structured PICO

Do echocardiographic stress, strain, and elastic modulus parameters accurately distinguish patients with significant coronary artery disease from those with non-significant disease?

Population

88 patients with suspected coronary artery disease (CAD) presenting with chest pain in the last 3 days and LVEF ≥50%. Exclusions included previous myocardial infarction, previous heart surgery, more than mild heart valve disease, hypertension, diabetes, eGFR <30 ml/min, LVEF <30%, and atrial fibrillation >100 bpm. The final cohort consisted of 64 patients with significant stenosis (>70%) requiring PCI and 24 controls with non-significant stenosis.

Intervention

Echocardiographic assessment of left ventricular physical parameters, including speckle tracking echocardiography for strain (GLS, GCS) and calculation of regional wall stress and elastic modulus using a thick-walled ellipsoidal model (Ghista-Sandler model), in patients with significant CAD.

Comparator

Echocardiographic assessment of the same left ventricular physical parameters in patients with non-significant CAD (control group).

Outcome

Diagnostic accuracy (Area Under the ROC Curve, sensitivity, specificity) of echocardiographic stress, strain, and elastic modulus parameters to distinguish patients with significant CAD requiring PCI.surrogate

Regional circumferential elastic modulus derived from 2D speckle tracking echocardiography and a thick-walled ellipsoidal model can non-invasively identify patients with significant coronary artery disease requiring intervention.

Abstract

Abstract BackgroundIn this study, physical parameters of the strain of left ventricle (LV), wall stress with a thick-walled ellipsoidal model, and elastic modulus of LV were extracted for distinguishing patients who were stent candidates.Materials and MethodsEighty-eight patients with suspected coronary artery disease (CAD) underwent echocardiography and angiography. Based on angiography results, the patients were divided into two groups (64 patients candidate for PCI (percutaneous coronary intervention) and 24 cases in the control group). Long-axis and short-axis echocardiographic views were acquired. Radial, longitudinal, and circumferential stress were estimated by the thick-walled ellipsoidal model. Circumferential strain (CS) and longitudinal strain (Ls) were obtained for 18 segments in the endocardium layer of LV, and then GLS (global longitudinal strain) and GCS (global circumferential strain) were calculated.ResultAnterior and inferoseptal circumferential wall stresses in end-systole (ES) were statistically significant (P0.05). Peak systolic GCS and GLS were lower in the PCI group (-18.13±3.03 and -16.57±2.88%) compared to the control group (-21.97±3.97 and 19.14±2.17%), respectively (p<0.05). The receiver operator characteristic curve (ROC) analysis revealed that GLS and GCS had the highest area under the ROC curve with a sensitivity of 83% and specificity of 63% for GLS and sensitivity of 71% and specificity of 59% for GCS.ConclusionStress and strain parameters are suggested as non-invasive and quantitative tools for measuring left ventricular function before angiography. Regional elastic modulus was a powerful predictor that can be distinguishing significant CAD patients.

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