The Behavior of Regional Longitudinal Strain Depends on Coronary Flow Reserve in a Simultaneous Analysis during Dipyridamole Stress Echocardiography

pp. 442-448

Abstract

Background: The relationship between regional and global longitudinal strain and coronary flow reserve has been poorly studied.

Objectives: The primary aim of this study was to compare the behavior of apical and global longitudinal strain with the coronary anterior descending artery flow reserve and the secondary aim was to compare these responses with the visual analysis of wall motion during dipyridamole stress echocardiography.

Methods: A retrospective study was performed including 179 patients (50.3% men, n=90) with mean age 68.7 ± 7.8 years. Coronary flow reserve was measured at peak dipyridamole effect, simultaneously with longitudinal strain and the visual analysis of contractility. Patients were divided into two groups: Group 1: Coronary flow reserve ≥2 and Group 2: <2. Apical strain was defined as the average of 4 apical segments and global strain as the average of the 17 segments. Any increase in strain was considered normal.

Results: One hundred and thirteen patients (63.12%) were included in Group 1 and 66 (36.87%) in Group 2. Apical strain: 96.77% of Group 1 patients increased their strain values with stress, while in Group 2, 95.31% worsened their strain values (p <0.0001). Global Strain: 82.8% of Group 1 patients increased their values, while in Group 2, 78.8% worsened their values (p <0.01). Post dipyridamole
wall motion analysis: 96.46% of Group 1 patients had preserved wall motion and only 54.5% of Group 2 showed this behavior (only 4 patients evidenced increased apical strain).

Conclusions: There was a close correlation between coronary flow reserve and apical longitudinal strain which was superior to the use of global longitudinal strain. Apical strain showed a better correlation with anterior descending artery coronary flow reserve than with the visual analysis of contractility.