Risk stratification of patients with non-ST-elevation acute coronary syndromes by assessing global longitudinal strain

Noninvasive detection of left main/three-vessel diseases (LM/3VD) among patients with non-ST-elevation acute coronary syndromes (NSTEACS) has been difficult using echocardiography. However, two-dimensional (2D) strain/strain-rate analysis is more sensitive in quantitatively assessing contractile abn...

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Bibliographic Details
Published in:Heart and vessels 2014-05, Vol.29 (3), p.300-307
Main Authors: Hoshi, Hiromi, Takagi, Atsushi, Uematsu, Shoko, Ashihara, Kyomi, Hagiwara, Nobuhisa
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - diagnostic imaging
Acute Coronary Syndrome - physiopathology
Acute coronary syndromes
Aged
Area Under Curve
Biomedical Engineering and Bioengineering
Cardiac Surgery
Cardiology
Coronary Angiography
Echocardiography, Doppler, Color
Electrocardiography
Female
Heart Ventricles - diagnostic imaging
Heart Ventricles - physiopathology
Humans
Image Interpretation, Computer-Assisted
Male
Medical imaging
Medicine
Medicine & Public Health
Middle Aged
Myocardial Contraction
Original Article
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
ROC Curve
Severity of Illness Index
Time Factors
Vascular Surgery
Ventricular Function, Left
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Summary:Noninvasive detection of left main/three-vessel diseases (LM/3VD) among patients with non-ST-elevation acute coronary syndromes (NSTEACS) has been difficult using echocardiography. However, two-dimensional (2D) strain/strain-rate analysis is more sensitive in quantitatively assessing contractile abnormality. Accordingly, we aimed to clarify the usefulness of 2D strain/strain-rate analysis for risk stratification of NSTEACS. A total of 50 patients with NSTEACS underwent echocardiography and coronary angiography. We evaluated global longitudinal peak strain (global PS), peak systolic strain rate (global SSR), early diastolic global peak strain rate (global ESR), time from aortic valve closure to peak strain (TAVC-global PS), and global ESR (TAVC-global ESR) in apical four-, two-, and three-chamber views. Patients were divided into two groups according to coronary angiographic findings, the high-risk group ( n = 15) with either of left main or three-vessel disease, and the low-risk group ( n = 35). There were no significant differences in global SSR and global ESR between the two groups. The amplitude of global PS was significantly reduced in high-risk patients with LM/3VD in comparison with low-risk patients (−17.5 ± 2.4 % vs −19.8 ± 2.7 %, P = 0.007, respectively). TAVC-global PS and TAVC-global ESR were significantly prolonged in high-risk patients with LM/3VD in comparison with low-risk patients (15.3 ± 25.7 ms vs −36.8 ± 32.7 ms, P < 0.0001 and 162.8 ± 32.7 ms vs 135.7 ± 41.5 ms, P < 0.03, respectively). Receiver-operating characteristic analysis demonstrated that TAVC-global PS most strongly detected high-risk patients with sensitivity of 100 % and specificity of 74.3 % (area under the curve = 0.938, 95 % confidence interval 0.832–0.986, P = 0.0001). Temporal analysis of 2D strain appeared to be useful in detecting high-risk patients with LM/3VD among patients with NSTEACS.
ISSN:0910-8327
1615-2573
DOI:10.1007/s00380-013-0361-y