Exercise stress echocardiography with cardiac function
parameters in coronary artery bypass grafting function assessment

    Authors

    Abstract

    **Introduction**: A more quantitative method for evaluation of stress echocardiography is introduced by measuring deformation (1-3). **Case report**: A 69-year old woman, formerly fitted with a double CABG, presents to the Polyclinic as a result of a new chest pain and shortness of breath on exertion. Exercise stress echocardiography with cardiac function parameters is performed: during the exercise, no cardiac arrhythmias and ECG signs of myocardial ischemia are shown, but testing is interrupted due to the leg pain at 71% of the theoretical maximum frequency. Immediate postpeak color Doppler derived long-axis systolic strain rate significantly decreases in midanteroseptal and basal posterior segment and insignificantly decreases in midinferior segment. Immediate postpeak parameters of diastolic function are borderline. MSCT coronary angiography: LIMA-LAD is flowing smoothly, with adequate flow through the distal LAD and collateral opacification of PD and PL. Long-lasting plaques with abundant calcifications are evident in the proximal segment ACx, therefore it is impossible to determine the degree of stenosis. The venous graft (VSM-RCA) is occluded. Coronary angiography: LAD at the beginning of the middle segment is suboccluded (99%), and then the competitive flow from the LIMA-LAD is seen. LIMA-LAD is in good condition and connection. After the attachment of the LIMA-LAD, LAD is diffusely altered with long, borderline (70%) stenosis. Borderline (50%) stenosis in the middle ACx segment is followed by a series of marginal changes. RCA is occluded at the end of the proximal segment. VSM-RCA bypass is of the proper flow and connection. **Conclusion**: Exercise stress echocardiography with the cardiac function parameters may reveal the alterations in the CABG function.

    Keywords

    exercise stress echocardiography, the coronary artery bypass grafting, deformation

    DOI

    https://doi.org/10.15836/ccar2021.49

    Literature

    1. Sutherland GR, Di Salvo G, Claus P, D’hooge J, Bijnens B. Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr. 2004 July;17(7):788–802. https://doi.org/10.1016/j.echo.2004.03.027
    2. Hanekom L, Cho GY, Leano R, Jeffriess L, Marwick TH. Comparison of two-dimensional speckle and tissue Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation. Eur Heart J. 2007 July;28(14):1765–72. https://doi.org/10.1093/eurheartj/ehm188
    3. Caballero L, Kou S, Dulgheru R, Gonjilashvili N, Athanassopoulos GD, Barone D, et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging. 2015 September;16(9):1031–41. https://doi.org/10.1093/ehjci/jev083
    Cardiologia Croatica
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    Exercise stress echocardiography with cardiac function
parameters in coronary artery bypass grafting function assessment

    Extended Abstract
    Issue1-2
    Published
    Pages49
    PDF via DOIhttps://doi.org/10.15836/ccar2021.49
    exercise stress echocardiography
    the coronary artery bypass grafting
    deformation

    Authors

    Ana Fabris*ORCIDThe Polyclinic for cardiovascular diseases and prevention Sveti Nikola, Korčula, Croatia

    *Correspondence email: fabrisana@yahoo.com

    Abstract

    **Introduction**: A more quantitative method for evaluation of stress echocardiography is introduced by measuring deformation (1-3). **Case report**: A 69-year old woman, formerly fitted with a double CABG, presents to the Polyclinic as a result of a new chest pain and shortness of breath on exertion. Exercise stress echocardiography with cardiac function parameters is performed: during the exercise, no cardiac arrhythmias and ECG signs of myocardial ischemia are shown, but testing is interrupted due to the leg pain at 71% of the theoretical maximum frequency. Immediate postpeak color Doppler derived long-axis systolic strain rate significantly decreases in midanteroseptal and basal posterior segment and insignificantly decreases in midinferior segment. Immediate postpeak parameters of diastolic function are borderline. MSCT coronary angiography: LIMA-LAD is flowing smoothly, with adequate flow through the distal LAD and collateral opacification of PD and PL. Long-lasting plaques with abundant calcifications are evident in the proximal segment ACx, therefore it is impossible to determine the degree of stenosis. The venous graft (VSM-RCA) is occluded. Coronary angiography: LAD at the beginning of the middle segment is suboccluded (99%), and then the competitive flow from the LIMA-LAD is seen. LIMA-LAD is in good condition and connection. After the attachment of the LIMA-LAD, LAD is diffusely altered with long, borderline (70%) stenosis. Borderline (50%) stenosis in the middle ACx segment is followed by a series of marginal changes. RCA is occluded at the end of the proximal segment. VSM-RCA bypass is of the proper flow and connection. **Conclusion**: Exercise stress echocardiography with the cardiac function parameters may reveal the alterations in the CABG function.

    Literature

    1. 1.
      Sutherland GR, Di Salvo G, Claus P, D’hooge J, Bijnens B. Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr. 2004 July;17(7):788–802.DOI
    2. 2.
      Hanekom L, Cho GY, Leano R, Jeffriess L, Marwick TH. Comparison of two-dimensional speckle and tissue Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation. Eur Heart J. 2007 July;28(14):1765–72.DOI
    3. 3.
      Caballero L, Kou S, Dulgheru R, Gonjilashvili N, Athanassopoulos GD, Barone D, et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging. 2015 September;16(9):1031–41.DOI