Fatih Mehmet UÇAR, Mustafa Adem YILMAZTEPE

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

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.

Anahtar Kelimeler:

Speckle tracking, sol atriyal strain, koroner yavaş akım

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

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,

PDF

___

1. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries--a new angiographic finding. Am Heart J 1972;84:66-71.
2. Li JJ, Qin XW, Li ZC, Zeng HS, Gao Z, Xu B, et al. Increased plasma C-reactive protein and interleukin-6 concentrations in patients with slow coronary flow. Clin Chim Acta 2007;385:43-7.
3. Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon--a new coronary microvascular disorder. Cardiology 2002;97:197-202.
4. Wang Y, Ma C, Zhang Y, Guan Z, Liu S, Li Y, et al. Assessment of left and right ventricular diastolic and systolic functions using two-dimensional speckle-tracking echocardiography in patients with coronary slow-flow phenomenon. PloS One 2015;10:e0117979.
5. Cameli M, Mandoli GE, Loiacono F, Dini FL, Henein M, Mondillo S. Left atrial strain: a new parameter for assessment of left ventricular filling pressure. Heart Failure Reviews 2016;21:65-76.
6. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93:879-88.
7. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-63.
8. Singh S, Kothari SS, Bahl VK. Coronary slow flow phenomenon: an angiographic curiosity. Indian Heart J 2004;56:613-7.
9. Sezgin AT, Topal E, Barutcu I, Ozdemir R, Gullu H, Bariskaner E, et al. Impaired left ventricle filling in slow coronary flow phenomenon: an echo-Doppler study. Angiology 2005;56:397-401.
10. Przybojewski JZ, Becker PH. Angina pectoris and acute myocardial infarction due to “slow-flow phenomenon” in nonatherosclerotic coronary arteries: a case report. Angiology 1986;37:751-61.
11. Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997;30:474-80.
12. Baykan M, Baykan EC, Turan S, Gedikli O, Kaplan S, Kiriş A, et al. Assessment of left ventricular function and Tei index by tissue Doppler imaging in patients with slow coronary flow. Echocardiography 2009;26:1167-72.
13. Zencir C, Cetin M, Gungor H, Akgüllü Ç, Eryılmaz U, Avcil M, et al. Evaluation of left ventricular systolic and diastolic functions in patients with coronary slow flow phenomenon. Türk Kardiyol Dern Arş 2013;41:691-6.
14. Perk G, Kronzon I. Non-Doppler two dimensional strain imaging for evaluation of coronary artery disease. Echocardiography 2009;26:299-306.
15. Tsai WC, Liu YW, Huang YY, Lin CC, Lee CH, Tsai LM. Diagnostic value of segmental longitudinal strain by automated function imaging in coronary artery disease without left ventricular dysfunction. J Am Soc Echocardiogr 2010;23:1183-9.
16. Kalay N, Celik A, Inanc T, Dogan A, Ozdogru I, Kaya MG, et al. Left ventricular strain and strain rate echocardiography analysis in patients with total and subtotal occlusion in the infarct-related left anterior descending artery. Echocardiography 2011;28:203-9.
17. Kimura K, Takenaka K, Pan X, Ebihara A, Uno K, Fukuda N, et al. Prediction of coronary artery stenosis using strain imaging diastolic index at rest in patients with preserved ejection fraction. J Cardiol 2011;57:311-5.
18. Nurkalem Z, Gorgulu S, Uslu N, Orhan AL, Alper AT, Erer B, et al. Longitudinal left ventricular systolic function is impaired in patients with coronary slow flow. Int J Cardiovasc Imaging 2009;25:25-32.
19. Cameli M, Lisi M, Focardi M, Reccia R, Natali BM, Sparla S, et al. Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol 2012;110:264-9.
20. Yan P, Sun B, Shi H, Zhu W, Zhou Q, Jiang Y, et al. Left atrial and right atrial deformation in patients with coronary artery disease: a velocity vector imaging-based study. PLoS One 2012;7:e51204.
21. O’Connor K, Magne J, Rosca M, Pierard LA, Lancellotti P. Left atrial function and remodelling in aortic stenosis. European Journal of Echocardiography 2011;12:299-305.
22. Wakami K, Ohte N, Asada K, Fukuta H, Goto T, Mukai S, et al. Correlation between left ventricular end-diastolic pressure and peak left atrial wall strain during left ventricular systole. J Am Soc Echocardiogr 2009;22:847-51.