Abnormal Left Atrial Pump Strain in Patients with Proximal Left Circumflex Coronary Artery Occlusion among Patients with ST-elevation Acute Coronary Syndrome

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Background: The left circumflex coronary artery (LCx) is the predominant source of blood supply to the left atrium. This study investigated whether discernable differences in left atrial strain exist among patients with ST-elevation acute coronary syndrome (STEACS) caused by LCx occlusion compared to that caused by occlusion of the left anterior descending (LAD) or right coronary artery (RCA) as well as between proximal and distal LCx occlusion. Methods: This observational study, conducted at Christian Medical College, Vellore, enrolled 43 patients presenting with STEACS who had undergone coronary angiography. Comprehensive echocardiography was performed during hospitalization, and left atrial function was assessed using the auto strain method of Philips Qlab software, version 9.0.5. Results: Among the 43 study patients, 20 (46.5%) had the LCx as the culprit artery, with 6/20 (30%) showing proximal LCx occlusion; culprit occlusions were seen in the LAD in 13 (30.2%) patients and RCA in 10 (23.3%) patients. The mean left atrial reservoir strain was 24.03 ± 10.96 in the LCx group, 19.13 ± 8.53 in the LAD group, and 31.25 ± 16.60 in the RCA group, with no significant difference between groups ( P = 0.064). When comparing proximal LCx occlusions with distal LCx occlusions and LAD/RCA occlusions, the mean left atrial pump strain (LAPS) was significantly lower in the proximal LCx group (2.4 ± 2.3) compared to the distal LCx group (14.9 ± 7.7) and the LAD/RCA groups (11.3 ± 7.8) ( P = 0.03). Mean left atrial reservoir strain trended lower in the proximal LCx group (15.8 ± 6.2) compared to the distal LCx group (27.5 ± 10.8) and the LAD/RCA group (24.2 ± 13.8), though this was statistically nonsignificant ( P = 0.074). In addition, left atrial pump strain was 11.17 ± 8.7 in the LCx group, 10.01 ± 6.75 in the LAD group, and 12.99 ± 9.07 in the RCA group, also without significant difference between groups ( P = 0.694). Conclusion: In STEACS, there are no significant differences in left atrial reservoir strain and left atrial pump strain between patients with culprit occlusions in the LCx, LAD, and RCA. However, left atrial pump strain is significantly lower in patients with proximal LCx culprit occlusions compared to those with distal LCx and LAD/RCA culprit occlusions; left atrial reservoir strain shows a similar but nonsignficant, trend.

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