Coronary-specific quantification of myocardial deformation by strain echocardiography may disclose the culprit vessel in patients with non-ST-segment elevation acute coronary syndrome. Issue 2 (25th February 2022)

• Record Type: Journal Article
• Authors: Guaricci, Andrea Igoren; Chiarello, Giuseppina; Gherbesi, Elisa; Fusini, Laura; Soldato, Nicolo'; Siena, Paola; Ursi, Raffaella; Ruggieri, Roberta; Guglielmo, Marco; Muscogiuri, Giuseppe; Baggiano, Andrea; Rabbat, Mark G; Memeo, Riccardo; Lepera, Mario; Favale, Stefano; Pontone, Gianluca
• Editors: Gimelli, Alessia
• Is Part Of: European Heart Journal Open. Volume 2:Issue 2(2022)
• Publication Date: 2022-02-25
• Subjects: 2D speckle tracking echocardiography -- Territorial longitudinal strain -- Non-ST-elevation myocardial infarction -- Culprit lesion; 616
• DOI: 10.1093/ehjopen/oeac010
• Languages: English
• ISSNs: 2752-4191

Abstract

Abstract: Aims: To compare the diagnostic accuracy of speckle tracking echocardiography 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 and eighty-three patients (mean age: 66 ± 12 years, male: 71%) diagnosed with NSTE-ACS underwent echocardiography evaluation at hospital admission and ICA within 24 h. Culprit vessels were left anterior descending (LAD), left circumflex (CX), and right coronary arteries (RCAs) in 38.5%, 39.6%, and 21.4%, respectively. An increase of affected vessels [1-, 2-, and 3-vessel coronary artery disease (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; and RCA, P = 0.019). Conclusion: Territorial longitudinal strain 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.