Badran Hala Mahfouz, Ibrahim Waleed Abdou, Alaksher Tamer, Soltan Ghada
Menoufia University, P.O box 34, 55-El Gish street, Tanta, Egypt.
National Heart Institute, Cairo, Egypt.
Egypt Heart J. 2020 Jun 3;72(1):33. doi: 10.1186/s43044-020-00059-z.
We examined the impact of left anterior descending (LAD) wrapping on left ventricular (LV) mechanics in patients with normal coronary angiography. Seventy-one patients with evidence of normal coronary angiography (LAD wrapping: n = 52, 73%) and LAD non-wrapping (n = 19, 27%) were included in the study. Using 2D-strain imaging, we measured LV longitudinal and circumferential (circ) strain (ε), systolic strain rate (SR), early (SR) and atrial (SR) diastolic SR, LV electromechanical dyssynchrony (TTP-SD), and LV twist and torsion in study groups.
No significant difference in age, gender, body surface area (BSA), or ejection fraction (EF%) between groups. LAD-wrapping group showed higher deceleration time (DT) (P < 0.0001), global longitudinal ε % (P < 0.02), circ SR at the basal segments (P < .02), circ SR and SR and SR (P < 0.0001) at the apical segments and apical rotation compared with the non-wrapped group. LV twist was correlated negatively with LV electromechanical dyssynchrony (r = .25, P < 0.03) and positively with longitudinal ε (r = .47, P < .0001), circ ε (r = .55, P < .0001), circ SR (r = .23, P < .05), and circ SR (r = .55, P < .0001). Using multivariate regression analysis, DT: OR 0.932, CI 0.877-0.991, and P < 0.02 and circ at atrial diastole (SR): OR 0.000, CI .000-.271, and P < 0.03 were independent predictors of LAD wrapping around LV apex.
Wrapped LAD is associated with better myocardial relaxation and rotational mechanics in patients with normal coronary angiography. This could explain the worse prognosis in such population when LAD occlusion acutely emerges.
我们研究了左前降支（LAD）包绕对冠状动脉造影正常患者左心室（LV）力学的影响。本研究纳入了71例冠状动脉造影正常的患者（LAD包绕：n = 52，73%；LAD未包绕：n = 19，27%）。我们使用二维应变成像测量了研究组的左心室纵向和圆周（circ）应变（ε）、收缩期应变率（SR）、早期（SR）和心房（SR）舒张期SR、左心室机电失同步（TTP-SD）以及左心室扭转和扭矩。
两组在年龄、性别、体表面积（BSA）或射血分数（EF%）方面无显著差异。与未包绕组相比，LAD包绕组显示出更长的减速时间（DT）（P < 0.0001）、更高的整体纵向ε%（P < 0.02）、基底节段的圆周SR（P <.02）、心尖节段的圆周SR以及SR和SR（P < 0.0001）和心尖旋转。左心室扭转与左心室机电失同步呈负相关（r =.25，P < 0.03），与纵向ε（r =.47，P <.0001）、圆周ε（r =.55，P <.0001）、圆周SR（r =.23，P <.05）和圆周SR（r =.55，P <.0001）呈正相关。使用多因素回归分析，DT：OR 0.932，CI 0.877 - 0.991，P < 0.02，以及心房舒张期圆周（SR）：OR 0.000，CI.000 -.271，P < 0.03是LAD包绕左心室心尖的独立预测因素。
在冠状动脉造影正常的患者中，包绕的LAD与更好的心肌舒张和旋转力学相关。这可以解释在这类人群中当LAD急性闭塞时预后更差的原因。
