Unmasking latent cardiac dysfunction in angina with non-obstructive coronary artery disease (ANOCA) patients: An advanced echocardiographic evaluation.

BACKGROUND

The pathophysiologic mechanisms underlying angina with non-obstructive coronary artery disease (ANOCA) are multifactorial, leading to myocardial injury and adverse cardiovascular events. The echocardiographic phenotyping of left ventricular function in patients with ANOCA is sparse.

METHODS

Of the 362 patients enrolled in the Coronary Microvascular Disease Registry (CMDR), eighty-eight ANOCA patients with available transthoracic echocardiograms were included in this cross-sectional study, after excluding patients with poor image quality and those with LVEF ≤40 %. Artificial intelligence-assisted quantitative echocardiography analysis, with additional meticulous tracking inspection as necessary, was performed using the Us2.v2 platform. FDA-approved/cleared parameters of left ventricular deformation, wall thickness, and diastolic function were evaluated. Left atrial (LA) reservoir strain was quantified manually by an experienced echocardiographer.

RESULTS

The mean age was 60 years (SD: 12), 72.7 % were female, and 65.5 % were Black. The mean LVEF was 60.4 % (SD: 6.5); 81.2 % of the patients had LVEF>55 %. Global longitudinal strain (GLS) was abnormal, as defined by GLS < 18 %, in 47.6 % of the patients. The majority (56 % to 70 %) had abnormal septal e' velocity (<7 cm/s), lateral e' velocity (<10 cm/s), and abnormal/borderline E/e' (≥8). LA reservoir strain was abnormal (<39 %) in 60 % of the patients. The proportion of patients with peak tricuspid regurgitation velocity > 2.8 m/s and LA volume index >34 mL/m2, suggesting significant diastolic impairment, was 10.4 % and 7.9 %. Abnormal interventricular septum and posterior wall diameters (>1.1 cm) were observed in 32.9 % and 23.5 %, respectively.

CONCLUSION

Our findings demonstrate a high prevalence of cardiac abnormalities, utilizing echocardiographic myocardial deformation parameters in patients with ANOCA.