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The Importance of Speckle Tracking Echocardiography Evaluating of Nonobstructive Coronary Artery Stenosis and Its Correlation with Microvascular Angina
Volume 31, Issue 3 (2020), pp. 523–538
Pub. online: 24 September 2020      Type: Research Article      Open accessOpen Access
Received
1 May 2020
Accepted
1 July 2020
Published
24 September 2020

Abstract

This study aims to evaluate patients with limited state of changes in coronary arteries detected by coronary angiography, the dynamics of these changes over the two years, identify the relevant diagnostic criteria, and assess the efficacy of applied treatment by using speckle tracking echocardiography. Peak radial and circumferential strain and SR (systolic, early, and late diastolic strains) were measured based on the short-axis view; peak longitudinal strain and SR were measured from the apical side of four- two- and three-chamber views. Radial, longitudinal (GLS), circumferential global and regional strains were calculated as an average of measurements. All patients $(n-146)$ were assigned to normal (control) and CAD groups according to cardiac angiography results. 128 of them were evaluated repeatedly after two years. Depending on angiography findings, LAD (85.83%) stenosis predominate, when subsequently fewer instances of RCA (52.5%) or LCX (40.83%) were observed. Most (about 80%) of the patients had one or two-vessel disease and only 20% had systemic all three-vessel disease. Analysis of STE data in groups during a two-year study period showed statistically reliable differences associated with a particular coronary artery. In the control group: RCA – myocardial circumferential strain $(p-0.037)$; LAD – no changes; LCX – early $(p-0.013)$ and late diastolic longitudinal $(p-0.033)$ strains. Subsequently, in the CAD group: RCA – diastolic circumferential strain rate $(p-0.007)$; LAD – myocardial longitudinal strain $(p-0.006)$, systolic longitudinal $(p-0.038)$ and circumferential strain $(p-0.012)$ rates, early diastolic circumferential $(p-0.008)$ and late diastolic longitudinal $(p-0.037)$ strain rates; LCX – myocardial longitudinal $(p-0.049)$ strain. Between groups, we detected significant changes in such circumferential strain rates, respectively: RCA – systolic $(p=0.037)$, early diastolic $(p=0.019)$, and late diastolic $(p=0.024)$ strain rates; LAD – no changes; LCX – early diastolic longitudinal strain $(p-0.004)$. The clinical condition of our patients over the two years has improved both in control and CAD groups, according to GLS. We hold the opinion that microvascular angina (MVA) may be responsible for such an improvement because the main diagnostic criteria and common treatment with ACE inhibitors, statins, β-blockers, antithrombotic, and nitrates was typical and effective for MVA treatment.

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Biographies

Morkunaite Kristina
k_morkunaites@gmail.com

Kristina Morkunaite graduated from Lithuanian University of Health Sciences in 2006. She finished residency of cardiology in 2011. She is currently a cardiologist at Interventional Cardiology Department, Lithuanian University of Health Sciences Clinical Hospital. She has published more than 20 articles in journals and conference proceedings. Field of interests: intracoronary interventions, advantages in TAVI intervention, and renal denervation procedures.

Platukis Tautvydas
tautvis3000@gmail.com

Tautvydas Platukis graduated from Lithuanian University of Health Sciences in 2016. He is currently a doctor resident of Lithuanian University of Health Sciences Clinical Hospital, Department of Cardiology. Field of interests: intracoronary interventions and general cardiology.

Rumbinaite Egle
egle.rumbinaite@gmail.com

Egle Rumbinaite (PhD 2018) is a cardiologist at the Cardiology Department, Lithuanian University of Health Sciences. She has published more than 30 papers in journals, books, and conference proceedings. Since 2016, she is a sub-investigator in five transcatheter mitral and tricuspid valve interventions. She is interested in coronary artery disease, valvular heart disease, heart failure, rest and stress echocardiography, transcatheter valve interventions.

Unikas Ramunas
ramunas.unikas@yahoo.com

Marcel Abras (PhD since 2014) is an associate professor Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic Moldova. Head of the Department of Interventional Cardiology, Institute of Cardiology. He has published 47 papers in journals, books, and conference proceedings. Field of interests: intracoronary interventions, including bifurcation lesion, left main and multivessel disease, STEMI and NSTEMI patients, advantages in TAVI intervention, and renal denervation procedures.

Skaudickas Darijus
darijusskaudickas@gmail.com

Ramunas Unikas (PhD since 2000) – interventional cardiologist, head of Interventional Cardiology Department, and cardiology professor at Lithuanian University of Health Sciences Clinical Hospital. The points of interest are diagnostics and interventional treatment of coronary heart disease, arterial hypertension, and structural heart disease. He is a cardiology textbook co-author and has published more than 100 papers in journals, books, and conference proceedings.

Abras Marcel
marcel.abras@usmf.md

Vincentas Veikutis (PhD since 1991), full professor, head researcher in lab. of Clinical Cardiology, Institute of Cardiology, Lithuanian University of Health Sciences. Published over 170 research papers. The main research interests include microcirculation and cardiac tissue ischemia as pathology marker investigations, cancer genesis, thermography and shock-wave US using in medical practice.

Veikutis Vincentas
vincentas.veikutis@lsmuni.lt

Darijus Skaudickas (PhD since 2006). Ass. Professor at Lithuanian University of Health Sciences Clinical Hospital. Published over 40 papers. Area of interests: application of the new methods in vascular origin lower body and small pelvis diseases, ultramagnetic therapy.

Mickuviene Narseta
narseta.mickuviene@lsmuni.lt

Narseta Mickuviene (PhD since 2000). Assoc. prof. N. Mickuviene is a senior researcher and endocrinologist–consultant in Neurosciences Institute of Lithuanian University of Health Sciences, also head of Department of Behavioural Medicine of Faculty of Nursing of LUHS. Editor for medicine, Biomedical research journal “Biomedicina” (in Lithuanian) and “Biomedicine” (in English). Her research interests include thyroid and brain, depression and cardiovascular disease, thyroid hormones and rehabilitation of patients with cardiovascular diseases. Total publications – 140, 31 of them are in Clarivate Analytics Web of Science journals. She is currently leading 3 national and international research projects.


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© 2020 Vilnius University
Open access article under the CC BY license.

Keywords
speckle tracking echocardiography stable angina coronary angiography microvascular angina

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