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Evaluation of left ventricular function in ischemia with non-obstructive coronary arteries: a research based on adenosine stress myocardial contrast echocardiography

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Abstract

Patients with ischemia with non-obstructive coronary arteries (INOCA) have an increased risk of adverse cardiovascular events in the future, which is widespread but underdiagnosed. The purpose of this study is to explore the application value of adenosine stress myocardial contrast echocardiography (ASMCE) in INOCA disease, so that clinicians can early identify and intervene patients with left ventricular function subclinical impairment in INOCA. We enrolled 118 patients with INOCA by ASMCE and invasive coronary angiography (ICA), 97 of whom had complete data. The study population was divided into two subgroups depending on coronary flow velocity reserve (CFVR): impaired CFVR group (n = 34) and normal CFVR group (n = 63). Global longitudinal strain endocardial myocardial (GLSendo), mid-myocardial (GLSmid) and epicardial myocardial (GLSepi) increased after stress in both groups; transmural strain, wall motion scored index (WMSI) and myocardial perfusion scored index (MPSI) increased and FORCE decreased in impaired CFVR group after stress, but there was no difference in normal group before and after stress. There was no significant difference in left ventricular myocardial mechanical parameters, including ΔGLSendo, ΔGLSmid, ΔGLSepi, GLSendo-epi Reserve, Δpeak strain dispersion (PSD), PSD Reserve between the two groups, but ΔEF, strain reserve and left ventricular contractile reserve (LVCR) in the impaired CFVR group were lower than those in the normal CFVR group, while ΔWMSI and ΔMPSI were increased. CFVR can be a clinically valuable indicator in the ASMCE diagnosis of patients with microvascular angina pectoris in INOCA. In the evaluation of left ventricular function in INOCA patients, attention should be paid not only to myocardial deformation, but also to the dynamic changes of LVCR and myocardial perfusion during peak hyperemia.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CFVR:

Coronary flow velocity reserve

EF:

Ejection fraction

LVCR:

Left ventricular contractile reserve

ASMCE:

Adenosine stress myocardial contrast echocardiography

ICA:

Invasive coronary angiography

GLS:

Global longitudinal strain

INOCA:

Ischemia with non-obstructive coronary arteries

MVA:

Microvascular angina

2D-STE:

Two-dimensional speckle tracking echocardiography

MCE:

Myocardial contrast echocardiography

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Funding

This study was supported by the kunming Health Commission Grant (Grant Numbers 2022-09-02-001).

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Author notes

  1. Li Zhao and Pengli Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasound, Yanan Hospital of Kunming City, Kunming, 650051, Yunnan, China

    Li Zhao, Qinghui Wang, Pengli Xu, Xuan Su, Qingyi Luo & Yunchuan Ding

Authors
  1. Li Zhao
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  2. Qinghui Wang
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  3. Pengli Xu
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  4. Xuan Su
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  5. Qingyi Luo
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Contributions

All authors contributed to the study conception and design. QW and YD proposed the conceptual design of the article, LZ performed the statistical analysis and drafted the manuscript, PX was responsible for image off-line analysis, and QL and XS were responsible for image acquisition. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Qinghui Wang.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Not applicable.

Ethical approval

Ethical approval for this study was given by the Medical Ethics Committee of Yanan Hospital of Kunming City (Ethics Approval Number 2022-062-01). This study was performed in line with the principles of the Declaration of Helsinki for the involvement of humans.

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Zhao, L., Wang, Q., Xu, P. et al. Evaluation of left ventricular function in ischemia with non-obstructive coronary arteries: a research based on adenosine stress myocardial contrast echocardiography. Int J Cardiovasc Imaging 39, 349–357 (2023). https://doi.org/10.1007/s10554-022-02740-7

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