Anterior papillary muscle strain predicts significant left anterior descending coronary artery stenosis in patients undergoing angiography

Abstract This study investigated the diagnostic potential of anterolateral papillary muscle (ALPM) strain measurements, assessed by echocardiography, in identifying significant left anterior descending coronary artery (LAD) stenosis. A prospective observational study was conducted on 130 patients undergoing elective coronary angiography (CAG). The study group comprised 65 patients with significant proximal LAD stenosis (≥ 70%), and the control group consisted of 65 patients with normal coronary arteries. All participants underwent transthoracic echocardiography (TTE), and ALPM longitudinal strain was measured. The association between LAD stenosis and ALPM strain was analyzed using logistic regression models, adjusting for potential confounders. Initial logistic regression analysis showed a statistically significant positive association between ALPM strain and coronary artery disease, indicating that an increase in ALPM strain was associated with increased odds of coronary artery disease (OR:1.07, CI 95%: 1.02 to 1.12; p:0.015). However, this association was insignificant after more restrictive adjustments for factors such as ejection fraction, E/E’ ratio, and global longitudinal strain (GLS). While unadjusted ALPM strain measurement demonstrated a statistically significant association with LAD stenosis in the initial analysis, ALPM strain as a standalone measure appears to have limited clinical utility for predicting or screening for significant LAD stenosis. Further research is needed to explore whether ALPM strain, when integrated with other echocardiographic parameters or clinical data, might offer incremental value in the diagnosis and risk stratification of LAD-related coronary artery disease.