اسم المؤلف:
علاء يوسف حسن
اسم المشرف:
هلال بهجت شوقي الصفار
المستخلص:
Imaging (TDI) is affected by increasing severity of coronary artery disease (CAD) among patients with stable angina pectoris and preserved ejection fraction.AIM OF STUDYTo determine the role of tissue Doppler in determining extent and severity of coronary artery disease.MethodsThis study includes eighty two (82) patients with chronic stable angina pectoris referred to tertiary cardiac centre for coronary angiography, 50 cases were males and 32 females and all patients were examined by echocardiography at first then coronary angiography; all patients had normal ejection fraction > 50 % as part of inclusion criteria, also each patient had been examined for : 1) Mitral inflow pulse Doppler parameters with early diastole E, late diastole A and ratio of E/A2) Pulse tissue Doppler parameters of mitral annulus; E : early diastolic motion , A : late diastolic motion , S : systolic motion and ratio of E/A.3) The ratio of early diastole mitral valve inflow to early diastolic motion ofmitral annulus tissue Doppler ( E / E) as marker of left ventricular filling pressure.The pulse tissue Doppler parameters as above in number 2 had been examined at six mitral annulus regions ( septal , lateral , anterior , inferior , posterior and anteroseptal ).After that diagnostic coronary angiography was done for all patients and results of coronary angiography ≥ 70 % angiographic stenosised vessels were considered significantly diseased and named as patients group , below that value considered non significant including normal vessels so the latter was considered as control group .Number of the above patients group (45 patients), and the control group (37 patients).The patients group also classified as ; those with LAD disease was named one vessel disease , LAD + LCX ( or ≥ 50 % LMS) was named two vessel disease 32 ,33 , and three vessels disease includes LAD + LCX + RCA .The 45 patients in the patients group subdivided into subgroups as following : 1) Patients with one vessel disease (16 patients).2) Patients with two vessel disease (14 patients). 3) Patients with three vessel disease (15 patients).Each one of the above subgroups that significantly angiographic stenosed were compared with patients of the control group for tissue Doppler parameters ( E , A , E/A,S ) regionally and globally.Regionally mean each TD parameter from one of six regions of mitral annulus e.g septal , lateral,anterior , inferior, posterior and anteroseptal was compared between the patient subgroups and the control group.Globally mean for each tissue Doppler parameters E, A, E/A, S take mean value for all six annulus regions to be compare between the patient subgroups and the control group.Each patient with significant coronary disease was matched with a control of the same age, sex, body mass index, and status regarding diabetes and hypertension.ResultsThe mean age of the all eighty two patients (82) that included in this study was (53.5±8.4) years, range (40 - 67) years, (50) male patients (61%), and (32) female patients (39%).The patients group with significantly angiographic stenosis was (45) patients, mean age (57±7.7) years, range (50 - 67) years, (27) male patients (60%) , and (18) female patients (40%).The patients group divided into subgroups as following : one vessel disease 16 patients (36%), two vessel disease 14 (31%) patients, three vessel disease 15 (33%) patients.The control group was (37) patients, mean age (50±9.2) years ,range ( 40 - 58) years , (23) male patients (62%) and (14) female patients (37%).From comparison between patients group with the control group;No significant difference regarding clinical baseline characters was found between the patients group and the control group ( p value >0.05).Notably, no significant difference was observed with regards to LVEF, echo. dimensions of the left heart chambers or conventional diastolic parameters ( p value > 0.05).Differences were founded mainly in echo. Pulse TD parameters from comparison between the subgroups of patients and the control group as the following : A. Global TD diastolic parameters : 1. Significantly reduced ratio of E/A in one vessel disease ( p value 0.032).2. Near normal and normal E/A ratio in two and three vessel disease respectively (mean no significant differences p value 0.085, 0.12 respectively).3. Significantly increased E/E in three vessels disease only ( p value 0.016) .B. Global TD systolic parameters : Significantly reduced S in two and three vessels disease ( P value 0.043 ,0.001 respectively).C. Regional TD parameters : Show significant reduction of regional S with only three vessels coronary artery disease in anterior, lateral and inferior regions ( p value 0.036,0.022,0.047 respectively).ConclusionTDI performed at rest reveals both diastolic and systolic dysfunction in patients with stable angina pectoris with significant coronary artery stenosis even when the ejection fraction is preserved and the nature of the cardiac dysfunction correlate with number of significantly diseased vessels.
