Could Mitral Valve and Mitral Annular Velocities and Left Atrial and Left Ventricular Wall Strain Predict the Presence of Coronary Artery Disease? A Case-Control Echocardiographic Study

Background: Coronary Artery Disease (CAD) is a major cause of morbidity and mortality world-wild. Thus, its early diagnosis and treatment could be life-saving. Mitral Valve (MV) and mitral annular velocities as well as left atrial and left ventricular wall strain have been claimed to be helpful for prediction of the presence of CAD. Objectives: This case-control study aimed to assess the predictive value of these echocardiographic parameters for detection of CAD. Methods: Eighty consecutive individuals referring with acute angina-like chest pain and requiring diagnostic coronary angiography and had a concomitant echocardiographic Left Ventricular Ejection Fraction (LVEF) ≥ 50% were divided into two groups: those with significant CAD (n = 45) and those with non-significant CAD (n = 35). Tissue Doppler Imaging (TDI) was employed for all participants. Peak early and late MV velocities (E and A, respectively), peak longitudinal systolic myocardial velocity (mitral S′), peak early and late diastolic velocities (e′ and a′, respectively) from medial mitral annulus, E/e′ ratio, peak Left Atrial (LA) strain, and Left Ventricular Global Longitudinal Strain (LV GLS) were measured and compared in the two groups. Chi-square and t-test were used to compare the two groups as appropriated. Multiple logistic regression was also performed to detect the impact of categorical variables on the predictors of the presence of CAD. Receiver operating characteristic curves were constructed as needed. A P value ≤ 0.05 was considered to be statistically significant. Results: Mitral S′ and E/e′ were significantly different in the two groups. Mitral S′ was lower and E/e′ was higher in the patients with CAD compared to the control group (P = 0.01 and P = 0.03, respectively). Considering 5.3 cm/sec as the cut-off point for mitral S′, sensitivity and specificity for significant CAD were 67.40% and 68.60%, respectively with an odds ratio of 0.275. The cut-off point for mitral E/e′ was defined as 12.65, with sensitivity and specificity for significant CAD to be 52.17% and 77.14%, respectively with an odds ratio of 1.249. Conclusion: This study showed that mitral S′ and E/e′ could predict the presence of significant CAD in patients with chest pain and preserved LVEF. Thus, TDI could be used as a simple, reliable, and non-invasive tool to achieve this goal.