Relation Between Left Atrial Strain Function and Coronary Slow Flow Phenomenon Using Two-Dimensional Speckle-Tracking Echocardiography

Abstract

Introduction: Coronary slow flow (CSF) phenomenon is a clinical entity characterized by a slow, opaque material reaching distal coronary arteries in patients with normal or noncritical coronary artery diseases. Strain imaging techniques are reliable methods for evaluating both global and regional cardiac functions. In this study, we planned to investigate the relationship between left atrial strain (LAS), which is the best noninvasive demonstrator of left ventricle diastolic dysfunction, and CSF.

Patients and Methods: Thirty-eight consecutive patients whose coronary angiography was performed and CSF was detected at our hospital between January and December 2016 were included in the study. Thirty-seven age and sex matched patients with normal coronary arteries were enrolled as a control group.

Results: The median age was 52 ± 10.4 years, and 54.1% patients were male. Peak atrial longitudinal strain and peak atrial contraction strain were lower in the CSF group than in the control group (32.84 ± 8.06 vs. 38.49 ± 6.42, p= 0.001 and p< 0.001, respectively). In addition, time to peak longitudinal strain was higher in CSF group when compared with control group (445 ± 58 vs. 407 ± 36, p= 0.001, respectively).

Conclusion: It is known that there is a relationship between CSF and diastolic dysfunction and it is also known that LAS, which can be measured using the speckle-tracking method, shows left ventricle filling pressure like invasive measurements. In this study, we found an association between LAS, which is an easily available, cheap, and noninvasive method, and CSF.

Keywords

• Speckle tracking,left atrial strain,coronary slow flow

İki Boyutlu Ekokardiyografik Speckle Tracking ile Değerlendirilen Sol Atriyal Strain Parametresinin Koroner Yavaş Akım Fenomeni ile İlişkisi

Abstract

Giriş: Koroner yavaş akım (KYA) fenomeni anjiyografik olarak koroner arterleri normal olan veya tıkayıcı kritik darlığı olmayan hastalarda koroner anjiyografi sırasında distal koroner arterlere opak madde ulaşmasının yavaş olmasıdır. Gerilim (strain) görüntülemesi tekniği hem global hem de bölgesel kalp fonksiyonları değerlendirmesinde oldukça güvenilir bir yöntemdir. Bu çalışmada sol ventrikül diyastolik disfonksiyonunun en iyi girişimsel olmayan göstericisi olan sol atriyal strain değeri ile koroner yavaş akım arasındaki ilişkiyi araştırmayı planladık.

Hastalar ve Yöntem: Hastanemizde Ocak 2016 ve Aralık 2016 tarihleri arasında koroner anjiyografi yapılmış ve KYA saptanan ardışık 38 hasta çalışmaya alınmıştır. Yaş ve cinsiyet açısından çalışma grubu ile benzerlik  gösteren ve normal koroner arterler saptanan 37 hasta ise kontrol grubu olarak çalışmamıza dahil edilmiştir. 

Bulgular: Hastaların yaş ortalaması 52 ± 10.4 ve erkek cinsiyet oranı %54.1’dir. Kontrol grubu ile kıyaslandığında global pik atriyal longitidunal strain (PALS) ve pik atriyal kontraksiyon strain (PACS) değerlerinin KYA grubunda azaldığını bulduk (32.84 ± 8.06’ya karşı 38.49 ± 6.42, p= 0.001 ve < 0.001, sırasıyla). Bununla birlikte pik longitidunal straine ulaşma süresi (TPLS)’nin koroner yavaş akım tespit edilen hastalarda daha uzun olduğunu tespit ettik (445 ± 58’e karşı 407 ± 36, p= 0.001).

Sonuç: Koroner yavaş akım ile sol ventrikül diyastolik disfonksiyonun ilişkili olduğu ve speckle trecking yöntemi ile ölçülen sol atriyal strain değerinin invaziv ölçümler kadar sol ventrikül doluş basıncını gösterdiği bilinmektedir. Biz çalışmamızda kolaylıkla uygulanabilen, ucuz ve  girişimsel olmayan bir yöntem olan sol atrial strain parametresi ile  koroner yavaş akım arasında pozitif bir ilişki saptadık.

Keywords

• Speckle tracking,sol atriyal strain,koroner yavaş akım

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