Abstract
BackgroundWe examined the impact of left anterior descending (LAD) wrapping on left ventricular (LV) mechanics in patients with normal coronary angiography. Seventy-one patients with evidence of normal coronary angiography (LAD wrapping: n = 52, 73%) and LAD non-wrapping (n = 19, 27%) were included in the study. Using 2D-strain imaging, we measured LV longitudinal and circumferential (circ) strain (εsys), systolic strain rate (SRsys), early (SRe) and atrial (SRa) diastolic SR, LV electromechanical dyssynchrony (TTP-SD), and LV twist and torsion in study groups.ResultsNo significant difference in age, gender, body surface area (BSA), or ejection fraction (EF%) between groups. LAD-wrapping group showed higher deceleration time (DT) (P < 0.0001), global longitudinal εsys % (P < 0.02), circ SRa at the basal segments (P < .02), circ SRsys and SRe, and SRa (P < 0.0001) at the apical segments and apical rotation compared with the non-wrapped group. LV twist was correlated negatively with LV electromechanical dyssynchrony (r = .25, P < 0.03) and positively with longitudinal εsys (r = .47, P < .0001), circ εsys% (r = .55, P < .0001), circ SRsys (r = .23, P < .05), and circ SRe (r = .55, P < .0001). Using multivariate regression analysis, DT: OR 0.932, CI 0.877–0.991, and P < 0.02 and circ at atrial diastole (SRa): OR 0.000, CI .000–.271, and P < 0.03 were independent predictors of LAD wrapping around LV apex.ConclusionWrapped LAD is associated with better myocardial relaxation and rotational mechanics in patients with normal coronary angiography. This could explain the worse prognosis in such population when LAD occlusion acutely emerges.
Highlights
We examined the impact of left anterior descending (LAD) wrapping on left ventricular (LV) mechanics in patients with normal coronary angiography
In total, 71 patients having angiographically normal coronary arteries were included in the study; those with a long LAD wraparound LV apex constituted 73% (LAD wrapping group, n = 52) and those with the LAD terminating at or before LV apex constituted 27% (LAD non-wrapping group, n = 19)
Patients with LAD wrapping have a higher prevalence of hypertension (62% versus 26%, P < .008), lower prevalence of diabetes mellitus (59.6% versus 100%, P < .001), and less prevalence of cigarette smoking (16% versus 46%, P < .000) compared with LAD non-wrapping
Summary
We examined the impact of left anterior descending (LAD) wrapping on left ventricular (LV) mechanics in patients with normal coronary angiography. The left anterior descending coronary artery (LAD) supplies blood flow to the greater part of the cardiac muscle. The LAD route may extend around the apex and terminates beyond the diaphragmatic aspect of the left ventricle (LV). LAD fails to continue on the diaphragmatic surface in 22% of patients; alternatively, it terminates at or even before the cardiac apex [4]. Further research work described the LAD coronary artery to be wrapped around the cardiac apex in 47% of individuals with right coronary artery dominance and in 87% of those with left coronary dominance [3]
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