Assessment of myocardial segmental function with coronary artery stenosis in multi-vessel coronary disease patients with normal wall motion.

OBJECTIVE: To discover the impact of the various degrees of coronary artery stenosis (CAD) on the left ventricular systolic dysfunction in steady state with quantitative analysis of the regional systolic myocardium in longitudinal, radial and circumferential direction in patients with coronary artery disease by two-dimensional speckle tracking imaging (STI). PATIENTS AND METHODS: Forty-three normal wall motion-multi vessel coronary artery disease (NWM-MVD) patients labeled as the experimental groups and forty-two subjects with little risk of CAD marked as the control group were enrolled in this study. The two-dimensional STI was obtained in the apical long axis and three levels of the short axis of the left ventricle. The left ventricular wall was divided into 18 segments. The affected myocardia were divided into three groups: group B (coronary stenosis degree ≤50%), group C (coronary stenosis degree 50%-99%)and group D (coronary stenosis degree ≥99%). Using the Q-analysis software, the longitudinal, radial and circumferential systolic strain (SL, SR, SC) and strain ratio (SrL, SrR, SrC) of the myocardium were analyzed. RESULTS: The bradycardia in the NWM-MVD group is greater than that in the control group (16/43 vs. 7/42, p <0.05). Compared with the control group, the SL and SR of group B, group C and group D decreased significantly (p <0.05). Compared with group C, the SL of group D also decreased significantly (p <0.05). However, there was no SC difference among the four groups. Meanwhile, compared with group A, the SrL, SrR and SrC of group B, group C and group D decreased significantly (p <0.05). Compared with group A, group B and group C, the SrL and SrC of group D also decreased (p <0.05). Compared with group A and group C, the SrR of group D decreased. The SrL was equal to 1.085 for the cut-off value, and the sum (1.348) of sensitivity (0.673) and specificity (0.675) were the greatest. Bland-Altman analysis showed that there was myocardium conformity of in both the multi-vessel CAD patients and the control subjects. CONCLUSIONS: Myocardial systolic function was impaired in the MVD patients of group B (coronary stenosis degree ≤50%), group C (coronary stenosis degree 50%-99%)and group D (coronary stenosis degree ≥99%), especially the longitudinal and radial systolic function, even though they had normal wall motion. The SrL equaled 1.085 for the cut-off value, and the sums (1.348) of sensitivity (0.673) and specificity (0.675) were the greatest. Bradycardia might be a compensatory mechanism in NWM-MVD patients.