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Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Evaluation of Left Ventricular Function in Patients with Coronary Slow Flow by the Dobutamine Stress Echocardiography

Author(s): Jian Wu, Shuang Meng, Hui Wang, Rongchong Huang* and Yanzong Yang*

Volume 18, Issue 12, 2022

Published on: 13 July, 2022

Article ID: e090522204427 Pages: 9

DOI: 10.2174/1573405618666220509121758

Price: $65

Abstract

Background: The study aims to assess the changes to left ventricular (LV) function of patients with the coronary slow flow (CSF) in response to stress induced by low dose dobutamine.

Methods: Based on coronary angiography (CAG) results, a total of 186 patients undergoing CAG for chest pain and suspected coronary heart disease were assigned to the CSF group (n = 142) and control group (n = 44). Patients in the CSF group underwent two-dimensional speckle-tracking echocardiography (STE) during the dobutamine stress test to evaluate LV systolic and diastolic functions.

Results: At rest, there were no statistically significant differences in LV peak systolic longitudinal strain (LS), LV peak systolic longitudinal strain rate (LSRs), LV peak early diastolic longitudinal strain rate (LSRed), LV circumferential strain (CS), or LV circumferential strain rate (CSRed) between the CSF and control groups. In the CSF group, LS and LSRs first increased as the infusion rate was increased to 10 μg/kg/min (all, p < 0.05), before decreasing at infusion rates of 15 and 20 μg/kg/min (all, p < 0.05). CS and CSRed increased in the CSF group at infusion rates of 5, 10, and 15 μg/kg/min, (all, p < 0.05), but decreased significantly at 20 μg/kg/min (all, p < 0.05).

Conclusion: At rest, LV systolic and diastolic functions were comparable between the CSF and control groups. However, when blood flow to the heart muscles was insufficient, LSRed decreased first, followed by LS. In terms of sensitivity to myocardial ischemia, LS is a better strain parameter than CS.

Keywords: Coronary slow flow, dobutamine stress echocardiography, left ventricular, diastolic functions, longitudinal strain rate.

Graphical Abstract
[1]
Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon--a new coronary microvascular disorder. Cardiology 2002; 97(4): 197-202.
[http://dx.doi.org/10.1159/000063121] [PMID: 12145474]
[2]
Montalescot G, Sechtem U, Achenbach S, et al. Task Force Members; ESC Committee for Practice Guidelines; Document Reviewers. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34(38): 2949-3003.
[http://dx.doi.org/10.1093/eurheartj/eht296] [PMID: 23996286]
[3]
Mangieri E, Macchiarelli G, Ciavolella M, et al. Slow coronary flow: Clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn 1996; 37(4): 375-81.
[http://dx.doi.org/10.1002/(SICI)1097-0304(199604)37:4<375::AID-CCD7>3.0.CO;2-8] [PMID: 8721694]
[4]
Saya S, Hennebry TA, Lozano P, Lazzara R, Schechter E. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: A case report and review of literature. Clin Cardiol 2008; 31(8): 352-5.
[http://dx.doi.org/10.1002/clc.20266] [PMID: 17957738]
[5]
Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG. American Society of Echocardiography. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 2007; 20(9): 1021-41.
[http://dx.doi.org/10.1016/j.echo.2007.07.003] [PMID: 17765820]
[6]
Sicari R, Nihoyannopoulos P, Evangelista A, et al. European Association of Echocardiography. Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur J Echocardiogr 2008; 9(4): 415-37.
[http://dx.doi.org/10.1093/ejechocard/jen175] [PMID: 18579481]
[7]
Joyce E, Hoogslag GE, Al Amri I, et al. Quantitative dobutamine stress echocardiography using speckle-tracking analysis versus conventional visual analysis for detection of significant coronary artery disease after st-segment elevation myocardial infarction. J Am Soc Echocardiogr 2015; 28(12): 1379-89.e1.
[http://dx.doi.org/10.1016/j.echo.2015.07.023] [PMID: 26307373]
[8]
Uusitalo V, Luotolahti M, Pietilä M, et al. Two-dimensional speckle-tracking during dobutamine stress echocardiography in the detection of myocardial ischemia in patients with suspected coronary artery disease. J Am Soc Echocardiogr 2016; 29(5): 470-479.e3.
[http://dx.doi.org/10.1016/j.echo.2015.12.013] [PMID: 26852941]
[9]
Altunkas F, Koc F, Ceyhan K, et al. The effect of slow coronary flow on right and left ventricular performance. Med Princ Pract 2014; 23(1): 34-9.
[http://dx.doi.org/10.1159/000355471] [PMID: 24217066]
[10]
Nurkalem Z, Gorgulu S, Uslu N, et al. Longitudinal left ventricular systolic function is impaired in patients with coronary slow flow. Int J Cardiovasc Imaging 2009; 25(1): 25-32.
[http://dx.doi.org/10.1007/s10554-008-9341-1] [PMID: 18626788]
[11]
Baykan M, Baykan EC, Turan S, et al. Assessment of left ventricular function and Tei index by tissue Doppler imaging in patients with slow coronary flow. Echocardiography 2009; 26(10): 1167-72.
[http://dx.doi.org/10.1111/j.1540-8175.2009.00939.x] [PMID: 19725862]
[12]
Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the american society of echocardiography and the european association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging 2016; 17(12): 1321-60.
[http://dx.doi.org/10.1093/ehjci/jew082] [PMID: 27422899]
[13]
Edvardsen T, Helle-Valle T, Smiseth OA. Systolic dysfunction in heart failure with normal ejection fraction: Speckle-tracking echocardiography. Prog Cardiovasc Dis 2006; 49(3): 207-14.
[http://dx.doi.org/10.1016/j.pcad.2006.08.008] [PMID: 17084180]
[14]
Yazici M, Demircan S, Durna K, Sahin M. The role of adrenergic activity in slow coronary flow and its relationship to TIMI frame count. Angiology 2007; 58(4): 393-400.
[http://dx.doi.org/10.1177/0003319707305118] [PMID: 17652227]
[15]
Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: A quantitative method of assessing coronary artery flow. Circulation 1996; 93(5): 879-88.
[http://dx.doi.org/10.1161/01.CIR.93.5.879] [PMID: 8598078]
[16]
LeWinter MM, Kent RS, Kroener JM, Carew TE, Covell JW. Regional differences in myocardial performance in the left ventricle of the dog. Circ Res 1975; 37(2): 191-9.
[http://dx.doi.org/10.1161/01.RES.37.2.191] [PMID: 1149193]
[17]
Sabbah HN, Marzilli M, Stein PD. The relative role of subendocardium and subepicardium in left ventricular mechanics. Am J Physiol 1981; 240(6): H920-6.
[PMID: 7246754]
[18]
Kimura K, Takenaka K, Ebihara A, et al. Reproducibility and diagnostic accuracy of three-layer speckle tracking echocardiography in a swine chronic ischemia model. Echocardiography 2011; 28(10): 1148-55.
[http://dx.doi.org/10.1111/j.1540-8175.2011.01517.x] [PMID: 21967399]
[19]
Ishizu T, Seo Y, Enomoto Y, et al. Experimental validation of left ventricular transmural strain gradient with echocardiographic two-dimensional speckle tracking imaging. Eur J Echocardiogr 2010; 11(4): 377-85.
[http://dx.doi.org/10.1093/ejechocard/jep221] [PMID: 20056658]
[20]
Ono S, Waldman LK, Yamashita H, Covell JW, Ross J Jr. Effect of coronary artery reperfusion on transmural myocardial remodeling in dogs. Circulation 1995; 91(4): 1143-53.
[http://dx.doi.org/10.1161/01.CIR.91.4.1143] [PMID: 7850953]
[21]
Cadeddu C, Nocco S, Deidda M, Pau F, Colonna P, Mercuro G. Altered transmural contractility in postmenopausal women affected by cardiac syndrome X. J Am Soc Echocardiogr 2014; 27(2): 208-14.
[http://dx.doi.org/10.1016/j.echo.2013.09.014] [PMID: 24161482]
[22]
Urheim S, Edvardsen T, Torp H, Angelsen B, Smiseth OA. Myocardial strain by Doppler echocardiography. Validation of a new method to quantify regional myocardial function. Circulation 2000; 102(10): 1158-64.
[http://dx.doi.org/10.1161/01.CIR.102.10.1158] [PMID: 10973846]
[23]
Helle-Valle T, Crosby J, Edvardsen T, et al. New noninvasive method for assessment of left ventricular rotation: Speckle tracking echocardiography. Circulation 2005; 112(20): 3149-56.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.104.531558] [PMID: 16286606]
[24]
Henson RE, Song SK, Pastorek JS, Ackerman JJ, Lorenz CH. Left ventricular torsion is equal in mice and humans. Am J Physiol Heart Circ Physiol 2000; 278(4): H1117-23.
[http://dx.doi.org/10.1152/ajpheart.2000.278.4.H1117] [PMID: 10749705]
[25]
Bansal M, Sengupta PP. Longitudinal and circumferential strain in patients with regional LV dysfunction. Curr Cardiol Rep 2013; 15(3): 339.
[http://dx.doi.org/10.1007/s11886-012-0339-x] [PMID: 23338721]
[26]
Wang Y, Ma C, Zhang Y, et al. Assessment of left and right ventricular diastolic and systolic functions using two-dimensional speckle-tracking echocardiography in patients with coronary slow-flow phenomenon. PLoS One 2015; 10(2): e0117979.
[http://dx.doi.org/10.1371/journal.pone.0117979] [PMID: 25706989]
[27]
Barutçu A, Bekler A, Temiz A, et al. Left ventricular twist mechanics Are impaired in patients with coronary slow flow. Echocardiography 2015; 32(11): 1647-54.
[http://dx.doi.org/10.1111/echo.12918] [PMID: 25739451]
[28]
Gulel O, Akcay M, Soylu K, et al. Left ventricular myocardial deformation parameters are affected by coronary slow flow phenomenon: A study of speckle tracking echocardiography. Echocardiography 2016; 33(5): 714-23.
[http://dx.doi.org/10.1111/echo.13146] [PMID: 26668075]
[29]
Bansal M, Cho GY, Chan J, Leano R, Haluska BA, Marwick TH. Feasibility and accuracy of different techniques of two-dimensional speckle based strain and validation with harmonic phase magnetic resonance imaging. J Am Soc Echocardiogr 2008; 21(12): 1318-25.
[http://dx.doi.org/10.1016/j.echo.2008.09.021] [PMID: 19041575]
[30]
Parker KM, Clark AP, Goodman NC, Glover DK, Holmes JW. Comparison of quantitative wall-motion analysis and strain for detection of coronary stenosis with three-dimensional dobutamine stress echocardiography. Echocardiography 2015; 32(2): 349-60.
[http://dx.doi.org/10.1111/echo.12636] [PMID: 24815588]
[31]
Popović ZB, Benejam C, Bian J, et al. Speckle-tracking echocardiography correctly identifies segmental left ventricular dysfunction induced by scarring in a rat model of myocardial infarction. Am J Physiol Heart Circ Physiol 2007; 292(6): H2809-16.
[http://dx.doi.org/10.1152/ajpheart.01176.2006] [PMID: 17277023]
[32]
Murai D, Yamada S, Hayashi T, et al. Relationships of left ventricular strain and strain rate to wall stress and their afterload dependency. Heart Vessels 2017; 32(5): 574-83.
[http://dx.doi.org/10.1007/s00380-016-0900-4] [PMID: 27734145]
[33]
Philouze C, Obert P, Nottin S, Benamor A, Barthez O, Aboukhoudir F. Dobutamine stress echocardiography unmasks early left ventricular dysfunction in asymptomatic patients with uncomplicated Type 2 Diabetes: A comprehensive two-dimensional speckle-tracking imaging study. J Am Soc Echocardiogr 2018; 31(5): 587-97.
[http://dx.doi.org/10.1016/j.echo.2017.12.006] [PMID: 29526563]

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