Abstract
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.
Highlights
Patients with angina and non-obstructive coronary artery stenosis (INOCA) are increasingly recognized in clinical practice
Of the 500 patients screened for suspected chronic coronary syndrome, 135 patients (26%) had normal coronary arteries and suspected microvascular angina
The main findings of this study can be summarized as follows: (i) the assessment of myocardial mechanics during vasodilator stress echocardiography is highly feasible (ii) patients with Ischemia and non-obstructive coronary artery stenosis (INOCA) and coronary microvascular dysfunction have reduced global longitudinal strain and increased dyssynchrony unmasked during stress, despite having normal wall motion. (iii) LVCR based on ejection fraction (EF) or load-independent force is not different in patients with normal or abnormal coronary flow velocity reserve (CFVR), while myocardial mechanics expressed by global and layer specific deformation indices is reduced in patients with INOCA and coronary microvascular dysfunction
Summary
Patients with angina and non-obstructive coronary artery stenosis (INOCA) are increasingly recognized in clinical practice. These patients are at higher risk of major adverse cardiovascular events [1–3], and experience recurrent symptoms. Vasodilator stress echocardiography allows to measure non-invasively coronary flow velocity reserve (CFVR) [6,7] and is recommended by current guidelines in patients with suspected microvascular angina [8]. We aimed to determine if microvascular angina, assessed by CFVR, might cause changes in myocardial mechanics during vasodilator stress echocardiography reflecting subclinical LV dysfunction and dyssynchrony. 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. Coronary microvascular dysfunction is accompanied by an impairment of global and layer-specific deformation indices during stress
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