Abstract 11469: Prediction of Coronary Artery Stenosis without Stress Test in Patients with Normal Left Ventricular Wall Motion: Segmental Analyses Using Strain Imaging Diastolic Index
Background: Non-invasive detection of coronary artery stenosis usually requires a stress test in patients without regional wall motion abnormalities (RWMA) at rest. On the other hand, abnormal regional left ventricular (LV) relaxation caused by myocardial ischemia may persist beyond recovery of induced ischemia. We aimed to determine whether segmental analyses of abnormal regional LV relaxation by 2D strain imaging (SI) at rest could predict coronary artery stenosis in the three major vessels in patients without RWMA.
Methods: We performed 2D speckle tracking echocardiography and coronary angiography in 82 patients (69.6±9.7years, LVEF 65.9±7.9%) without RWMA who were suspected of coronary artery disease. Patients with LV dysfunction or with acute coronary syndrome were excluded. Echocardiographic images of LV were obtained in the apical 4-, 3-, and 2-chamver views and divided into 6 segments respectively. In each segment, strain imaging diastolic index (SI-DI) derived from transverse SI was determined.
Results: Forty-seven patients had significant coronary artery stenosis (>70%) on coronary angiography. Best cut-off values of SI-DI for detecting significant coronary artery stenosis in the three major vessels were 0.61 in mid antero-septum segment for the left anterior descending artery (sensitivity 0.84 and specificity 0.87), 0.61 in basal antero-lateral segment for the left circumferential artery (sensitivity 0.84 and specificity 0.93), and 0.62 in basal infero-septum segment for the right coronary artery (sensitivity 0.71 and specificity 0.85), respectively.
Conclusion: A segmental analysis of transverse SI-DI at rest predicts coronary artery stenosis in the three major vessels respectively even in patients without RWMA. This method is useful for detecting patients with CAD without a stress test.
- © 2011 by American Heart Association, Inc.