Coronary-specific quantification of myocardial deformation by strain echocardiography may disclose the culprit vessel in patients with non-ST-segment elevation acute coronary syndrome

Abstract

Aims To compare the diagnostic accuracy of speckle tracking echocardiography (STE) technique using territorial longitudinal strain (TLS) for the detection of culprit vessel vs. vessel-specific wall motion score index (WMSI) in non-ST segment elevation-acute coronary syndrome (NSTE-ACS) patients scheduled for invasive coronary angiography (ICA). Methods and Results One-hundred-eighty-three patients (mean age: 66±12 years, male: 71%) diagnosed with NSTE-ACS underwent echocardiography evaluation at hospital admission and ICA within 24 hours. Culprit vessels were left anterior descending (LAD), left circumflex (CX) and right coronary arteries (RCA) in 38.5%, 39.6% and 21.4%, respectively. An increase of affected vessels (1-,2-,3-vessel CAD) was associated with increased WMSI and TLS values. There was a statistically significant difference of both WMSI-LAD, WMSI-CX, WMSI-RCA and TLS-LAD, TLS-CX, TLS-RCA of myocardial segments with underlying severe CAD compared to no CAD (p = 0.001 and p < 0.001, respectively). Moreover, a significant difference of TLS-LAD, TLS-CX, TLS-RCA and WMSI-CX of myocardial segments with an underlying culprit vessel compared to non culprit vessels (p < 0.001, p < 0.001, p = 0.022 and p < 0.001 respectively) was identified. WMSI-LAD and WMSI-RCA did not show statistical significant differences. A regression model revealed that the combination of WMSI + TLS was more accurate compared to WMSI alone in detecting the culprit vessel (LAD p = 0.001, CX p < 0.001, RCA p = 0.019). Conclusion TLS allows an accurate identification of the culprit vessel in NSTE-ACS patients. In addition to WMSI, TLS may be considered as part of routine echocardiography for better clinical assessment in this subset of patients.

Improvement of Left Ventricular Global Longitudinal Strain after 6-Month Therapy with GLP-1RAs Semaglutide and Dulaglutide in Type 2 Diabetes Mellitus: A Pilot Study

“…GLS-STE represents an innovative technique for the evaluation of myocardial function [ 21 , 22 ]. Numerous studies have shown its incremental diagnostic and prognostic value in multiple cardiovascular conditions, such as ischaemic heart disease [ 52 ] and cardiomyopathies [ 53 ]. Indeed, despite the normal values of LVEF, the evidence of the early impairment of LV GLS reveals a subclinical systolic dysfunction that may evolve towards clinically relevant systolic impairment and cardiac complications [ 23 , 54 ].…”

Assessment and management of Heart Failure in Patients with Chronic Kidney Disease

“…Furthermore, the repetition of the echocardiogram is useful even when a change in the clinical picture suggests a change in ventricular function. Additional techniques such as Tissue Doppler Imaging (TDI) and Strain Rate (SR) should be incorporated into the protocol to identify patients who are at risk of HF or to identify early worsening of HF [50,51]. Hassanin N et al, showed that in patients with CKD, LV longitudinal systolic strain and early and late diastolic strain rates are significantly reduced despite preserved FE, identifying early patients at high risk of developing HF [52].…”

Multimodality Imaging of Sudden Cardiac Death and Acute Complications in Acute Coronary Syndrome

“…This is due both to its feasibility as a bedside diagnostic technique and to the relatively recent application to assess aspects of myocardial mechanics and advanced systolic and diastolic function [ 44 , 45 , 46 , 47 ]. The first aim of the echocardiographic examination in cases of ACS is to assess the presence and extension of kinesis abnormalities, which represent markers of ischemia (hypo-dys-akinesia) [ 44 , 48 , 49 , 50 ]. In addition, echocardiography helps physicians to assess overall ventricular volumes and left ventricle ejection fraction (LVEF), possible extension of ischemia to the right ventricle, subsequent pericardial disease, and possible mechanical complications [ 51 , 52 ].…”

“…Prediction of ventricular arrhythmias after MI is challenging. Echocardiographic evaluation of the global systolic function assessed by LVEF still remains the primary approach to stratify patients with ACS at high risk of SCD [ 49 ]. SCD is most frequently caused by ventricular arrhythmias resulting from electrical and mechanical changes in the affected myocardium and may be prevented by an implantable cardioverter-defibrillator (ICD) [ 84 ].…”