Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway.
Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Int J Cardiovasc Imaging. 2024 Oct;40(10):2077-2086. doi: 10.1007/s10554-024-03200-0. Epub 2024 Aug 23.
Patients with acute coronary artery disease (CAD) exhibit reduced global and regional strain and strain rate (S/SR). However, knowledge about segmental S/SR in stable CAD patients is still limited. This study aimed to investigate whether resting segmental S/SR measurements differ in patients with chronic chest pain who have normal coronary arteries or stenotic coronary arteries, and to compare these measurements to those in patients with revascularized myocardial infarction (MI). We prospectively enrolled 510 patients with chronic chest pain referred for coronary computed tomography angiography (CCTA) and 102 patients revascularized after MI. All participants underwent transthoracic echocardiography featuring S/SR analysis. In addition to the patients with MI, patients with suspected CAD based on CCTA findings subsequently underwent invasive coronary angiography (CAG). We assessed global longitudinal strain (GLS) and averaged segmental peak longitudinal strain during systole (PLS), peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), and post systolic shortening (PSS). We also determined functionally reduced segment percentages using differing S/SR cut-off values. There were significant disparities in all average segmental S/SR metrics between the No-CAD and MI groups. SRe was the only S/SR metric that differed significantly between the No-CAD and PCI groups. Differences in SRe, PLS and GLS measurements were observed between the No-CAD and CABG groups. The proportion of diminished segmental S/SR mirrored these findings. For the percentage of pathological segments with varying cut-off values, segmental SRe below 1.5 s displayed the most marked difference among the four groups (p < 0.001). Revascularized MI patients or those referred to CABG present with diminished segmental S/SR values. However, among patients with chronic chest pain, only segmental SRe discerns subtle disparities between the No-CAD and the PCI group. The diagnostic accuracy of SRe warrants further exploration in subsequent studies.
患有急性冠状动脉疾病（CAD）的患者表现出整体和局部应变和应变速率（S/SR）降低。然而，对于稳定 CAD 患者节段 S/SR 的了解仍然有限。本研究旨在探讨慢性胸痛患者中，冠状动脉正常或狭窄的患者静息节段 S/SR 测量值是否不同，并将这些测量值与经再血管化治疗的心肌梗死（MI）患者进行比较。我们前瞻性地招募了 510 名因冠状动脉计算机断层扫描血管造影（CCTA）而转诊的慢性胸痛患者和 102 名经再血管化治疗的 MI 患者。所有参与者均接受了 transthoracic echocardiography 进行 S/SR 分析。除了 MI 患者外，根据 CCTA 结果怀疑患有 CAD 的患者随后接受了冠状动脉造影（CAG）。我们评估了整体纵向应变（GLS）和平均节段收缩期峰值纵向应变（PLS）、收缩期峰值应变率（SRs）、收缩早期舒张期应变率（SRe）和收缩后期缩短（PSS）。我们还使用不同的 S/SR 截止值确定功能减少的节段百分比。在 No-CAD 和 MI 组之间，所有平均节段 S/SR 指标均存在显著差异。SRe 是 No-CAD 和 PCI 组之间唯一有显著差异的 S/SR 指标。在 No-CAD 和 CABG 组之间观察到 SRe、PLS 和 GLS 测量值的差异。节段性 S/SR 减少的节段比例反映了这些发现。对于不同截止值的病理性节段百分比，四个组中 SRe 低于 1.5s 的比例差异最显著（p<0.001）。经再血管化治疗的 MI 患者或转诊至 CABG 的患者存在节段性 S/SR 值降低。然而，在慢性胸痛患者中，只有节段 SRe 能够区分 No-CAD 和 PCI 组之间的细微差异。SRe 的诊断准确性值得在后续研究中进一步探讨。
