학술논문
Vasodilator Strain Stress Echocardiography in Suspected Coronary Microvascular Angina
Document Type
article
Author
Hugo Rodriguez-Zanella; Rosina Arbucci; Juan Francisco Fritche-Salazar; Xochitl Arely Ortiz-Leon; Domenico Tuttolomondo; Diego Haber Lowenstein; Karina Wierzbowska-Drabik; Quirino Ciampi; Jarosław D. Kasprzak; Nicola Gaibazzi; Jorge Lowenstein; Edith Liliana Posada-Martinez; Jose Antonio Arias-Godinez; Juan C. de la Fuente-Mancera; Eugenio Picano; on behalf of the Stress Echo 2020 Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)
Source
Journal of Clinical Medicine, Vol 11, Iss 3, p 711 (2022)
Subject
Language
English
ISSN
2077-0383
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.