Changes in right ventricular free wall strain in patients with coronary artery disease involving the right coronary artery

Wei-Ting Chang, Wei-Chuan Tsai, Yen-Wen Liu, Cheng-Han Lee, Ping-Yen Liu, Ju-Yi Chen, Yi-Heng Li, Liang-Miin Tsai
Journal of the American Society of Echocardiography 2014, 27 (3): 230-8

BACKGROUND: Chronic ischemia related occult systolic dysfunction of the right ventricle is difficult to detect using traditional echocardiography. The aim of this study was to verify the diagnostic value of speckle-tracking echocardiography in proximal right coronary artery (pRCA) lesion-induced right ventricular (RV) occult dysfunction.

METHODS: One hundred forty-two patients undergoing elective coronary angiography for suspected coronary artery disease were divided into two groups according to involvement of the right coronary artery. In further analysis, significant stenosis before the acute marginal branch was defined as pRCA involvement and compared with a control group. Global longitudinal strain and RV free wall longitudinal train (RVLS-FW) were measured using speckle-tracking echocardiography. Other traditional parameters to evaluate RV function were also measured.

RESULTS: Eighty-seven patients in the right coronary artery group (61.2%) displayed significant decreases in the magnitudes of both global longitudinal strain (-13.65 ± 3.83% vs -15.69 ± 4.37%, P = .04) and RVLS-FW (-16.04 ± 5.4% vs -21.18 ± 4.6%, P = .04), independent of other parameters. Conversely, when focusing on pRCA involvement, only RVLS-FW showed significant attenuation in the group with pRCA involvement (-14.26 ± 4.32% vs -19.96 ± 4.8%, P = .001). On multivariate analysis, RVLS-FW was still independently lower in the group with pRCA involvement (odds ratio, 1.07; 95% confidence interval, 1.01-1.14; P = .02).

CONCLUSIONS: The results of this study show that RVLS-FW was independently impaired in patients with coronary artery disease with right coronary artery stenosis, especially with involvement of the acute marginal branches. RV strain can be used to detect occult RV dysfunction in patients with stable coronary artery disease.

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