Extent of coronary atherosclerosis is associated with deterioration of left ventricular global longitudinal strain in patients with preserved ejection fraction undergoing coronary computed tomography angiography

Abstract

Background: This study aimed to investigate the association between the extent and severity of coronary atherosclerosis, epicardial adipose tissue (EAT) accumulation, and left ventricular (LV) global longitudinal strain (GLS) in patients with preserved LV ejection fraction (LVEF) and without LV regional wall motion abnormalities.

Methods: This study included 169 preserved LVEF patients without LV wall motion abnormalities who underwent coronary computed tomography (CT) angiography for the assessment of suspected coronary artery disease (CAD). The segment stenosis score (SSS) and segment involvement score (SIS) were calculated to evaluate CAD extent. The EAT volume was defined as CT attenuation values ranging from -250 to -30 HU within the pericardial sac. LVGLS was measured using echocardiography to assess subclinical LV dysfunction.

Results: All patients had preserved LVEF of ≥50%, and the mean LVGLS was -18.7% (-20.5% to -16.9%). Mean SSS and SIS were 2.0 (0-5) and 4.0 (0-36), respectively, while mean EAT volume was 116.1 mL (22.9-282.5 mL). Multivariate analysis using linear regression model demonstrated that LVEF (β, -17.0; 95% CI, -20.9 - -13.1), LV mass index (β, 0.03; 95% CI, 0.01-0.06), and EAT volume (β, 0.010; 95% CI, 0.0020-0.0195) were independently associated with LVGLS; however, obstructive CAD was not. The multivariate models demonstrated that SSS (Î, 0.12; 95% CI, 0.05-0.18) and SIS (Î, 0.27; 95% CI, 0.10-0.44) were correlated with deterioration of LVGLS, independent of other parameters.

Conclusion: This study demonstrates that EAT volume and CAD extent are associated with the deterioration of LVGLS in this population.

Keywords: Coronary atherosclerosis; Coronary computed tomography angiography; Epicardial adipose tissue; Heart failure; Longitudinal strain.

Fig. 1

A representative case of increased EAT volume with coronary atherosclerosis and impaired LVGLS. A 61-year male with obstructive CAD and increased EAT volume (A) and CAD extent (B) showing impaired LVGLS (C). (A) EAT volume, 194 mL; (B) nonobstructive CAD with a CACS of 440.6 Agatston units; (C) impaired LVGLS, −14.8%; LVGLS was calculated by averaging the negative peak strain from 18 ventricular segments from the apical 4-chamber, 2-chamber, and long-axis views.

Fig. 2

Association of LVGLS with patients with CAD stratified by CAD categories.

Fig. 3

Correlations between CAD extent or EAT volume and LVGLS. Spearman correlation demonstrated a significant correlation between SSS and LVGLS (A), between SIS and LVGLS (B), and between EAT volume and LVGLS (C).