Predictive value of global and territorial longitudinal strain imaging in detecting significant coronary artery disease in patients with myocardial infarction without persistent ST‐segment elevation

Abstract

Introduction Two‐dimensional (2D) speckle‐tracking echocardiographic (STE) imaging is frequently performed in the assessment of cardiovascular diseases. We aim to investigate the role of the global and territorial longitudinal strain (GLS and TLS) values assessed via 2D STE imaging to detect significant coronary artery disease (CAD) in non‐ST‐segment elevation myocardial infarction (NSTEMI) patients without wall‐motion abnormalities. Methods This study enrolled 150 patients with the diagnosis of NSTEMI. Patients who had typical chest pain with unstable angina characteristics within the last 24 hours were 18–80 years of age and had a typical rise and/or fall of cardiac biomarkers were included. Myocardial functions were assessed via myocardial deformation analyses of 2D STE images. Results The mean age of the CAD group was 52.91 ± 9.11, vs 50.31 ± 8.32 in the control group. In the CAD group, 56 patients were male (65%), whereas 21 were male (60%) in control group. GLS and TLS assessments demonstrated a statistically significant difference between CAD and control groups, with GLS values of −16.27 ± 1.91 and −18.74 ± 1.93 (P < 0.001), TLS‐LAD values of −15.67 ± 1.83 and −18.54 ± 1.97 (P < 0.001), TLS‐RCA values of −17.04 ± 1.81 and −19.20 ± 1.86 (P < 0.001), and TLS‐Cx values of −17.40 ± 2.08 and −18.34 ± 2.18 (P = 0.028), respectively. Correlation analyses revealed that as high‐sensitivity troponin (hsTnT) values increased, GLS decreased significantly, and further, an increase in severity of CAD resulted in decreased TLS‐LAD, ‐CX and ‐RCA (TLS‐LAD: P < 0.001, r = −0.743; TLS‐CX: P < 0.001, r = −0.449; TLS‐RCA: P < 0.001, r = −0.737). Multivariate analyses indicated that GLS and GRACE ACS risk scores are independent predictors of CAD in patients with NSTEMI (GLS: OR = 0.514, P < 0.001; GRACE score: OR = 0.938, P = 0.007). Conclusions Global longitudinal strain (GLS) assessed with 2D STE is a promising, easy to perform and quick imaging method to predict CAD in patients with NSTEMI.

Diagnostic Value of Global and Regional Myocardial Work in Coronary Artery Disease with Normal Ejection Fraction and Wall Motion

“…We also found that MWs in LAD segments had higher diagnostic value than MWs in LCX or RCA territories. In consistency with previous studies, the accuracy of 2D-STE was greater in the LAD territory, compared with other territories [22][23][24]. In our study, most MWs in LAD and RCA segments can predict relevant stenoses.…”

Utility of Longitudinal Strain Imaging by Speckle Tracking in Predicting Obstructive Coronary Artery Disease in Patients without Regional Wall Motion Abnormality on 2D Echocardiography

“…In addition, as the high sensitivity troponin values increased, the GLS decreased significantly. 10 Thus, quantification of strain abnormalities can have prognostic value in acute coronary syndromes.…”

“…(9)Early major OM was considered an intermedio-lateral branch and the antero-lateral overlap territory was assigned to it. (10) PDA and PLB lesions were assigned to RCA or LCX depending on the dominance. In a co-dominant system, depending on which vessel had the lesion, the analysis was done.…”

Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021

“…Após um período de 2 semanas, pode ocorrer melhora acentuada da função ventricular. 301 Com as novas tecnologias desenvolvidas nos aparelhos de ecocardiografia, como speckle-tracking 2D, tem sido possível, por meio da análise do strain global longitudinal (SGL) das paredes do VE, diagnosticar precocemente alterações isquêmicas em pacientes com alteração de troponina, porém sem alteração do ECG ou ecocardiograma de repouso (25% a 75% dos paciente com SCA têm ecocardiograma normal). 302 O SGL (quando < 16,5%) pode complementar algoritmos diagnósticos existentes e agir como marcador adjunto precoce de isquemia.…”