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

Andrea Igoren Guaricci*, Giuseppina Chiarello, Elisa Gherbesi, Laura Fusini, Nicolo' Soldato, Paola Siena, Raffaella Ursi, Roberta Ruggieri, Marco Guglielmo, Giuseppe Muscogiuri, Andrea Baggiano, Mark G. Rabbat, Riccardo Memeo, Mario Lepera, Stefano Favale, Gianluca Pontone

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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 þ 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.

Original languageEnglish
Article numberoeac010
JournalEuropean heart journal open
Volume2
Issue number2
DOIs
Publication statusPublished - 1 Mar 2022
Externally publishedYes

Keywords

  • 2D speckle tracking echocardiography
  • Culprit lesion
  • Non-ST-elevation myocardial infarction
  • Territorial longitudinal strain

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