Global Longitudinal Strain as Predictor of Inducible Ischemia in No Obstructive Coronary Artery Disease in the CIAO-ISCHEMIA Study.

BACKGROUND

Global longitudinal strain (GLS) is a sensitive marker for identifying subclinical myocardial dysfunction in obstructive coronary artery disease (CAD). Little is known about the relationship between GLS and ischemia in patients with myocardial ischemia and no obstructive CAD (INOCA).

OBJECTIVES

To investigate the relationship between resting GLS and ischemia on stress echocardiography (SE) in patients with INOCA.

METHODS

Left ventricular GLS was calculated offline on resting SE images at enrollment (n = 144) and 1-year follow-up (n = 120) in the CIAO-ISCHEMIA (Changes in Ischemia and Angina over One year in International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial screen failures with no obstructive CAD on computed tomography [CT] angiography) study, which enrolled participants with moderate or severe ischemia by local SE interpretation (≥3 segments with new or worsening wall motion abnormality and no obstructive (<50% stenosis) on coronary computed tomography angiography.

RESULTS

Global longitudinal strain values were normal in 83.3% at enrollment and 94.2% at follow-up. Global longitudinal strain values were not associated with a positive SE at enrollment (GLS = -21.5% positive SE vs GLS = -19.9% negative SE, P = .443) or follow-up (GLS = -23.2% positive SE vs GLS = -23.1% negative SE, P = .859). Significant change in GLS was not associated with positive SE in follow-up (P = .401). Regional strain was not associated with colocalizing ischemia at enrollment or follow-up. Changes in GLS and number of ischemic segments from enrollment to follow-up showed a modest but not clinically meaningful correlation (β = 0.41; 95% CI, 0.16, 0.67; P = .002).

CONCLUSIONS

In this cohort of INOCA patients, resting GLS values were largely normal and did not associate with the presence, severity, or location of stress-induced ischemia. These findings may suggest the absence of subclinical myocardial dysfunction detectable by echocardiographic strain analysis at rest in INOCA.

Informations de copyright

Copyright © 2023. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Conflicts of Interest J.P. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. J.L.-S. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study; grants from Bayer; grants and personal fees from Pfizer; personal fees from Menarini; grants and personal fees from Sanofi; grants from Merck; grants and personal fees from Boeringher Infleheim; and grants from Amgen outside the submitted work. R.S. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study; he also reports speaker fees from Lantheus Medical Imaging, Bracco, and Philips Healthcare. M.D.S. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. He also serves on the Scientific Advisory Board for Regeneron and Amgen. P.A.P. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. K.A. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. K.A.-N. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. R.A. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Y.X. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. D.M.K. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. J.A.S. reports grants from the National Heart, Lung, and Blood Institute, during the conduct of the study; personal fees from Bayer, Novartis, AstraZeneca, Amgen, Janssen, and United Healthcare; and grants from the American College of Cardiology, outside the submitted work. In addition, he has a patent Copyright to Seattle Angina Questionnaire with royalties paid and is on the Board of Directors for Blue Cross Blue Shield of Kansas City and Equity in Health Outcomes Sciences. J.H. is principal investigator for the ISCHEMIA trial for which, in addition to support by a National Heart, Lung, and Blood Institute grant, devices and medications were provided by Abbott Vascular, Medtronic, Abbott Laboratories (formerly St. Jude Medical), Royal Philips NV (formerly Volcano Corporation), Arbor Pharmaceuticals, AstraZeneca Pharmaceuticals, Merck Sharp & Dohme, Omron Healthcare, Sunovion Pharmaceuticals, Espero BioPharma; financial donations were provided by Arbor Pharmaceuticals LLC and AstraZeneca Pharmaceuticals LP. D.M. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. M.H.P. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. H.R.R. reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study, nonfinancial support from Abbott Vascular, Philips, SHL Telemedicine, and Siemens outside the submitted work. The remaining authors report no conflicts of interest.