Abstract
Objective To evaluate the abnormal myocardial perfusion in patients with INOCA using adenosine-stressed myocardial contrast echocardiography (AS-MCE) combined with myocardial work (MW).
Methods A total of 102 patients who underwent coronary angiography (CAG) or Coronary Artery CT Angiography (CCTA) for chest pain in Shaanxi Provincial People's Hospital from January 2022 to January 2024 were enrolled, those with normal results were then examined by AS-MCE, and 42 patients with INOCA results were classified as the INOCA group, while 30 normal results were classified as the control group. Conventional parameters were measured by two-dimensional echocardiography, left ventricular ejection fraction (Simpson's method) was measured, and the global longitudinal strain (GLS) and MW parameters of the left ventricle were analyzed by the Echo PAC (version 203) workstation. The myocardial perfusion parameters: peak signal intensity (A-value), curve upward slope (β value) and A×β value (reflecting myocardial blood volume) were obtained by analyzing the perfusion parameters of each group of all subjects under rest and stress states using QLab software, and the differences between the above two groups were compared.
Results The INOCA group and the control group did not show significant differences in gender, age, heart rate, weight, height, body surface area, prevalence of hypertension and diabetes, hyperlipidemia, alcohol history, smoking history, and conventional ultrasound parameters such as left atrial diameter, left ventricular end-systolic and end-diastolic diameters and volumes, LVEF, diastolic mitral valve velocity, E/A, e, EDT, E/e, MW parameters, and A-value, β-value, and A-× β value at rest (P>0.05, Table 1). However, after hypertension medication, the parameters in the INOCA group decreased significantly compared to those in the control group, and the β-value in the INOCA group was significantly lower than that in the control group at rest (P<0.05).
Conclusion Compared to myocardial work, adenosine-stressed myocardial echocardiography is more suitable for the clinical diagnosis of ischemia with non-obstructive coronary artery disease and its application is worthy of clinical practice promotion.