Evaluation of longitudinal left ventricular function in patients with coronary artery ectasia and vitamin D deficiency by 2D speckle tracking echocardiography

Evaluation of cardiac chamber functions by speckle-tracking echocardiography in the presence of coronary artery flow disturbances other than stenosis: A review

Conditions other than stenosis also disturb the coronary flow. Such conditions include the coronary slow flow phenomenon, coronary artery ectasia, and coronary artery tortuosity. Evidence exists regarding myocardial dysfunction in these conditions. In this review, we present studies that have used speckle-tracking echocardiography to determine whether coronary flow disturbances are accompanied by myocardial dysfunction. Additionally, we seek to show the gaps in knowledge concerning this issue and the dimensions that future studies should consider.

Is Coronary Artery Ectasia a Progressive Disease? A Self-Controlled Retrospective Cohort Study

Objective: It is essential to understand whether coronary artery ectasia (CAE) progresses over time because the patients might be under the risk of coronary rupture, and stent implant should be avoided if ectatic changes progress.

Methods: A consecutive series of 99 CAE patients who had undergone coronary angiography at least twice were enrolled and followed up for 1–16 years until they received a second angiogram. Subjects were divided into two groups (1–5 vs. 5–16 years of follow-up), then the basic clinical characteristics and coronary artery images were compared over time.

Results: (1) All CAE patients exhibited atherosclerosis, and a majority presented with acute myocardial infarction. Most baseline clinical characteristics were relatively stable. (2) Atherosclerosis (indicated by the distribution of stenosis in coronary vessels) and the Gensini scores progressed significantly. Ectasia extent showed minimal changes as indicated by blood vessel involvement, Markis type, coronary blood flow, ectasia diameter, and ectasia length. (3) Multilinear regression analysis revealed that the underlying factors related to stenosis evolution indicated by fold of Gensini score were: longer time interval, lower baseline Gensini score, and higher hypersensitive C-reactive protein concentration. (4) There was a relationship between the ectatic diameter and the extent of stenosis.

Conclusions: For CAE patients with atherosclerosis followed for 1–16 years, there was minimal CAE progression, while the atherosclerosis progressed and the ectasia extent was related to degree of stenosis. The results indicate that prevention and treatment of atherosclerotic changes might have more clinical significance than addressing ectatic changes.

The effect of native vitamin D therapy on echocardiographic parameters of patients with chronic obstructive pulmonary disease and early-stage chronic kidney disease

Aim. To assess the dynamics of the main echocardiographic parameters in patients with chronic obstructive pulmonary disease (COPD) and early-stage chronic kidney disease (CKD) taking native vitamin D.

Material and methods. The study included 264 patients, which were divided into two groups: experimental group (n=135) — patients with stage 2-4 COPD (men, mean age — 72,2±3,8 years, mean disease duration — 23,1±3,4 years); control group (n=136) — patients with stage 2-4 COPD, comparable in age and sex. Patients of both groups were divided into 4 subgroups depending on forced expiratory volume in 1 second and vitamin D levels. In the experimental group, native vitamin D therapy was performed according to regimen that maintains its level >34,3 ng/ml during the year; in the control group — according to the Russian Association of Endocrinologists guidelines. Echocardiography was performed for all patients at the beginning and end of the study.

Results. In all subgroups of the experimental group, a statistically significant increase in the left ventricular ejection fraction was revealed (p<0,05); in patients with moderate COPD (GOLD 2) and vitamin D deficiency and patients with severe and very severe COPD (GOLD 3,4) and vitamin D insufficiency of the experimental group, we observed a significant decrease in the end-systolic dimension, average left atrial size and increase in stroke volume and stroke volume index, as well as normalization of the left ventricular geometry (p<0,05). In the control group after 12 months, no significant changes were detected.

Conclusion. Maintaining of vitamin D level >34,3 ng/ml for 12 months in patients with COPD and early-stage CKD was associated with a significant improvement in myocardial remodeling. This indicates an improvement in cardiovascular adaptation and function.

Assessment of the impact of isolated coronary artery ectasia on left ventricular functions with 3D speckle-tracking echocardiography

BACKGROUND

Coronary artery ectasia (CAE) is an angiographic definition of coronary artery pathology in which the diameter of the ectatic segment measures more than 1.5 times the diameter of an adjacent healthy reference segment. No previous study has reported on the use of 3D-STE for assessing the left ventricular (LV) functions in patients with isolated CAE. As a result of this, we aimed to evaluate the effects of isolated CAE on LV functions using 3D-STE in the present study.

METHODS

Ninety-one patients with isolated CAE and 90 controls who proved to have normal coronary angiograms were enrolled to the study. 3D-STE was performed and GLS, GCS, GAS, and GRS were obtained for every subject after coronary angiography.

RESULTS

The mean age of the patients was 61.75 ± 10.02 years, and 71.8% were male. GLS, GCS, GAS, and GRS were significantly depressed in the isolated CAE group than in the control group (P < .001; P < .001; P = .001; and P = .001, respectively). ROC analyses were performed to find out the ideal strain cut off values to predict the presence of isolated CAE. A GLS value of >-16 has 92.1 % sensitivity, 88.5 % specificity; and a GCS value of >-20 has 86.7 % sensitivity, 89.2 % specificity to detect the presence of isolated CAE.

CONCLUSION

Isolated CAE has a considerable negative effect on LV functions as evaluated by 3D-strain parameters, and 3D-STE could be an effective method to detect early stage myocardial impairment in patients with isolated CAE.

Two-dimensional speckle-tracking echocardiographic evaluation of the longitudinal deformation of the left ventricular myocardium in patients with severe coronary artery tortuosity

PURPOSE

Coronary artery tortuosity (CAT) is an anatomical condition in which epicardial coronary arteries have abnormal curves or spiral courses. Although correlated with higher rates of positive stress test, its effects on the myocardial function remain to be clearly defined.

METHODS

We included in this cross-sectional study and evaluated with 2D speckle-tracking echocardiography 40 consecutive patients admitted to our hospital for selective coronary angiography which showed severe CAT without significant epicardial coronary artery stenosis, and 40 consecutive subjects matched for age, hypertension, and diabetes in whom selective coronary angiography showed neither CAT nor significant epicardial coronary artery stenosis.

RESULTS

Systolic strain, strain rate, and early and late diastolic strain rates were not significantly different between the 2 groups, even after adjustment for potential confounding variables.

CONCLUSION

The 2D speckle-tracking echocardiography-derived indices of longitudinal deformation of the left ventricular myocardium were not significantly different between the patients with severe CAT and controls.