Applicability of Longitudinal Strain of Left Ventricle in Unstable Angina

Abstract

BackgroundUnstable angina (UA) is a common cause of hospital admission; risk stratification helps determine strategies for treatment.ObjectiveTo determine the applicability of two-dimensional longitudinal strain (SL2D) for the identification of myocardial ischemia in patients with UA.MethodsCross-sectional, descriptive, observational study lasting 60 days. The sample consisted of 78 patients, of which fifteen (19.2%) were eligible for longitudinal strain analysis. The value of p < 0.05 was considered significant.ResultsThe group of ineligible patients presented: a lower proportion of women, a higher prevalence of diabetes mellitus (DM), use of ASA, statins and beta-blockers and larger cavity diameters. The main causes of non-applicability were: presence of previous infarction (56.4%), previous CTA (22.1%), previous MRI (11.5%) or both (16.7%) and the presence of specific electrocardiographic abnormalities (12.8%). SL2D assessment revealed a lower global strain value in those with stenosis greater than 70% in some epicardial coronary arteries (17.1 [3.1] versus 20.2 [6.7], with p = 0.014). Segmental strain assessment showed an association between severe CX and RD lesions with longitudinal strain reduction of lateral and inferior walls basal segments; (14 [5] versus 21 [10], with p = 0.04) and (12.5 [6] versus 19 [8], respectively).ConclusionThere was very low SL2D applicability to assess ischemia in the studied population. However, the global strain showed a correlation with the presence of significant coronary lesion, which could be included in the UA diagnostic arsenal in the future.

Left ventricular longitudinal global strain to predict severe coronary disease in patients with precordial pain suggestive of non-ST-segment elevation acute coronary syndrome

“…Two-dimensional echocardiography with speckle tracking is a validated technique that measures the strain (deformation) of the left ventricular wall. [ 3 4 5 ] It allows more accurate evaluation of left ventricular segmental and global systolic function than the visual changes assessed with traditional echocardiographic methods. [ 3 6 ]…”

Assessment of left ventricular contractility in acute inferior wall myocardial infarction by speckle tracking echocardiography

“…При дискинезе стенки ЛЖ в отсутствие коронарного атеросклероза, например при стрессовой кардиомиопатии и псевдодискинезе на фоне сдавления нижней стенки ЛЖ диафрагмой, показатели сегментарной деформации остаются в норме [26,27]. В то же время при нестабильной стенокардии стеноз более 70% правой коронарной и огибающей артерий снижал продольную сегментарную деформацию соответственно базального нижнего (с -19 до -12,5%) и базального бокового (с -21 до -14%) сегментов ЛЖ в отсутствие нарушения локальной сократимости [25]. По нашим данным, наличие и степень локальной дисфункции не влияют на степень снижения сегментарной деформации (медиана варьировала от -9 до -15%).…”