الفهرس 
Anatomy and physiology of Coronary circulationOnly 14 pages are availabe for public view
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Abstract
This study is a single center case control; observational study, its aim is to assess and validate 2 Dimensional long axis myocardial strain for the detection of myocardial ischemia in patients with significant coronary artery stenosis without visual wall motion abnormalities at rest.
This study included 40 patients categorized into two groups, Group A that included 30 patients with significant coronary artery disease and no visual segmental wall motion abnormalities, whom underwent coronary angiography within 6 months before inclusion in the study, their age ranged between 40-60 years. Group B that included 10 subjects with chest pain and normal coronary angiography, age matched with group A as a control group.
All of these patients are subjected to full history taking, physical examination, resting 12 lead ECG, coronary angiography and transthoracic echocardiography (Conventional 2D echo. and 2D myocardial strain)
Comparisons between groups (A&B)) of patients with special emphasis on clinical, echocardiographic, and myocardial segments strains were done.
With reference to the clinical characteristics there was no a statistically significant difference (P>0.05) between group (A&B) as regards age, sex, DM, Smoking, Dyslipidemia and family history of coronary artery disease.
With reference to the echocardiographic characteristics there was no statistically significant difference between Groups (A&B) in the study (P>0.05) as regards LVEDD & EF but there is significant difference between them in LVESD as (P <0.05).
The main finding of our study was that 2D long axis myocardial strain can localize ischemic segments supplied by a coronary artery with significant >70% stenosis in patients with out visual wall motion abnormality at rest, for example single LAD >70% stenosis that affect the mid anterior septal, mid inferior septal, mid inferior, apical anterior, apical septal and apex while in patients with single RCA >70% stenosis that affect the basal anterior, basal inferior septal, basal inferior, mid inferior septal, mid inferior & apical lateral segments as shown from the results that there is statistically significant decrease (P<0.05) in the long axis myocardial strain of myocardial segments supplied by those vessels.
In patients having 2 vessels with significant >70% stenosis of LAD & RCA there is significant difference at basal anterior, basal anterior septal, basal inferior septal, basal inferior, basal posterior lateral, mid anterior, mid anterior septal, mid inferior septal, mid inferior, mid anterior lateral, apical anterior, apical septal and apical lateral segments while in patients with LAD & C X thee is significant difference at basal anterior, basal inferior septal, basal inferior, mid anterior, mid inferior septal, mid inferior, apical septal and apical lateral segments as (P<0.05) in long axis myocardial strain of theses segments.
ROC curves of mid segments strain revealed 70.5% sensitivity, 86.6% specifity and cutoff value -17.5.
Therefore, long axis myocardial strain is a good diagnostic tool for diagnosis of coronary artery disease in comparison to wall motion scoring.