Evaluation of subclinical LV systolic dysfunction by global longitudinal strain using 2D-speckle tracking echocardiography in patients having angina with normal epicardial coronary arteries

Type of funding sources: Other. Main funding source(s): Self

Global longitudinal strain (GLS), assessed by 2D speckle tracking echocardiography would be a trustworthy noninvasive tool to detect subclinical LV systolic dysfunction in patients having angina with normal epicardial coronary arteries.

The primary objective of the study to detect subclinical LV systolic dysfunction by GLS using 2D-STE in patient having angina with normal coronary arteries and also by conventional echocardiogram at baseline.

This was a comparative case control study that was conducted during the period of  March 2018 to August 2018. The study included 60  patients who have been suffering from angina like syndrome despite normal coronary arteries along with 60 normal healthy individuals . All subjects were assessed by transthoracic echocardiography (TTE ) and GLS using 2D speckle-tracking analysis to assess resting LV systolic function . The results of all three planes in GLS (the apical four-chamber , two-chamber , and three-chamber  views) were combined in a single bull’s eye summary (agreeing with the standard 17-segment model), which presented the analysis of each segment along with a global peak systolic strain value for the LV.

This study identified normal reference value of the mean GLS in healthy control group was  −19.7 ± 1.84%.  GLS assessed by 2D STE was significantly impaired in patients having angina like syndrome with normal epicardial coronary arteries (-18.78 ± 1.87 vs -19.7 ± 1.84%;  p < 0.007) than healthy control group despite preserved  LVEF. In case group, 8 out of 60 patients (13.3 %) had more negative global longitudinal strain than control  subject.

Patients having angina with normal epicardial coronary arteries are likely to have microvascular disease. GLS assessed by 2D STE has the potential to improve the value of conventional echocardiography in the detection of the coronary microvascular disease. Despite normal LVEF, significant impairment of LV global longitudinal systolic function  can differentiate microvascular  group of  patients from others who have angina with  normal coronaries.