Risk stratification of patients with non-ST-elevation acute coronary syndromes by assessing global longitudinal
Hiromi Hoshi1, Atsushi Takagi, Shoko Uematsu
1Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Insights
Two-dimensional (2D) strain analysis, particularly the time from aortic valve closure to peak strain (TAVC-global PS), effectively identifies high-risk patients with left main/three-vessel disease (LM/3VD) among those with non-ST-elevation acute coronary syndromes (NSTEACS). This noninvasive method aids in crucial risk stratification for NSTEACS patients.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Noninvasive detection of left main/three-vessel diseases (LM/3VD) in non-ST-elevation acute coronary syndromes (NSTEACS) is challenging with standard echocardiography.
- Two-dimensional (2D) strain and strain-rate analysis offer enhanced sensitivity for quantifying myocardial contractile abnormalities.
Purpose of the Study:
- To evaluate the utility of 2D strain/strain-rate analysis for risk stratification in patients with NSTEACS.
- To determine if specific 2D strain parameters can identify patients with high-risk coronary artery disease.
Main Methods:
- Echocardiography and coronary angiography were performed on 50 NSTEACS patients.
- Evaluated parameters included global longitudinal peak strain (global PS), peak systolic strain rate (global SSR), early diastolic global peak strain rate (global ESR), and temporal parameters (TAVC-global PS, TAVC-global ESR).
- Patients were stratified into high-risk (LM/3VD, n=15) and low-risk (n=35) groups based on angiography.
Main Results:
- Global SSR and global ESR showed no significant differences between groups.
- Global PS amplitude was significantly reduced in the high-risk group (-17.5 ± 2.4% vs -19.8 ± 2.7%, P = 0.007).
- Temporal parameters TAVC-global PS and TAVC-global ESR were significantly prolonged in high-risk patients (P < 0.0001 and P < 0.03, respectively). TAVC-global PS demonstrated 100% sensitivity and 74.3% specificity (AUC = 0.938).
Conclusions:
- Temporal analysis of 2D strain, specifically TAVC-global PS, is a valuable noninvasive tool for detecting high-risk LM/3VD in NSTEACS patients.
- This technique aids in risk stratification, potentially guiding clinical management decisions.
- 2D strain analysis offers a sensitive method to assess myocardial function and identify significant coronary artery disease.
Abstract:
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.
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