Acute coronary occlusion in non-ST-elevation acute coronary syndrome: outcome and early identification by strain echocardiography. Issue 19 (18th July 2010)

• Record Type: Journal Article
• Authors: Grenne, Bjørnar; Eek, Christian; Sjøli, Benthe; Dahlslett, Thomas; Uchto, Michael; Hol, Per K; Skulstad, Helge; Smiseth, Otto A; Edvardsen, Thor; Brunvand, Harald
• Is Part Of: Heart. Volume 96:Issue 19(2010)
• Page Start: 1550
• Page End: 1556
• Publication Date: 2010-07-18
• Subjects: Coronary angioplasty (PCI) -- risk stratification -- acute coronary syndrome -- coronary artery disease (CAD) -- NSTEMI; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2009.188391
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: To compare infarct size and left ventricular ejection fraction in patients with non-ST-elevation myocardial infarction (NSTEMI) with and without acute coronary occlusions, and determine if myocardial strain by speckle-tracking echocardiography can identify acute occlusions in patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods: 111 patients with suspected NSTE-ACS were enrolled shortly after admittance. Echocardiographic measurements were performed a median of 1 h (interquartile range 0.5–4) after admittance, and coronary angiography 36±21 h after onset of symptoms. Territorial longitudinal and circumferential strain was calculated based on the perfusion territories of the three major coronary arteries in a 16-segment model of the left ventricle, and compared with traditional echocardiographic parameters. Long-term follow-up was by echocardiography and contrast-enhanced magnetic resonance imaging (ceMRI). Results: Patients with NSTEMI due to acute coronary occlusion had higher peak troponin T than patients with NSTEMI without acute occlusions (4.9±4.7 vs 0.9±1.1 μg/l, p<0.001), larger infarct size by ceMRI (13±8% vs 3±3%, p<0.001) and poorer left ventricular ejection fraction (48±6% vs 57±6%, p<0.001) at follow-up. Territorial circumferential strain was the best parameter for predicting acute coronary occlusion. A territorial circumferential strain value >−10.0% had 90% sensitivity, 88% specificity and area under the curve=0.93 for identification of acute occlusions. Conclusions: Patients with NSTEMI due to acute coronary occlusions develop larger infarcts and more impaired left ventricular function than patients with NSTEMI without occlusions, regardless of infarct-related territory. Territorial circumferential strain by echocardiography enables very early identification of acute coronary occlusions in patients with NSTE-ACS and may be used for detection of patients requiring urgent revascularisation.