Abstract 17808: Increased Left Ventricular Apical Rotation and Rotation Rate at Rest Predicts Significant Coronary Artery Disease in Patients with Diabetes
Introduction: Identifying patients with Diabetes that have significant coronary artery disease (CAD) is challenging, with little data to support current non-invasive screening strategies. Analyses of the speckle pattern associated with two-dimensional echocardiographic images can provide sensitive measures of myocardial function and may be abnormal in patients with significant CAD at rest. Animal models of ischemia have shown an increase in left ventricular (LV) apical rotation, thought secondary to a reduction in function of opposing sub-endocardial fibers. The Objectives of this study was to determine whether significant CAD in patients with Diabetes could be detected at rest, without the need for stress testing, using alterations in apical rotation measured by speckle-tracking echocardiography.
Methods: 72 consecutive Diabetic patients scheduled for diagnostic cardiac catheterization for suspected CAD, had resting echocardiograms performed using a GE Vivid 7 imaging system. These patients had normal LV ejection fraction and no prior history of myocardial infarction or coronary revascularization. Rotation and rotation rate were measured from the short axis of the LV apex using speckle-tracking software (GE EchoPac). Significant CAD was defined as 70% or greater stenosis of a major coronary artery.
Results: Clinical and echocardiographic data are shown in Table 1. Four patients were excluded from analysis because of poor image quality. There was a marked increase in peak LV apical rotation (LVrotS) and systolic rotation rate (LVrotrateS) as well as diastolic early untwisting rate (LVrotrateE) in patients with Diabetes and significant CAD.
Conclusions: Increased LV apical rotation and rotation rate at rest is associated with significant CAD in patients with Diabetes. These results suggest that LV apical rotation analysis may provide a novel approach for identifying obstructive CAD without resorting to stress testing in this high-risk population.
- © 2010 by American Heart Association, Inc.