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.