Application of Layered Strain Technique in NSTE-ACS

To explore the application value of layered strain technique in non-ST elevation acute coronary syndrome (NSTE-ACS).

120 patients with suspected NSTE-ACS undergoing coronary angiography in our hospital from December 2018 to December 2019 were prospectively selected. According to the results of coronary angiography, the patients were divided into the significant CAD group and the nonsignificant CAD group. Echocardiography was performed 1-2 hours before invasive coronary angiography. The long axis and circumferential strain of the endocardium, myocardial layer, and epicardium were evaluated by the layered strain technique. The territorial longitudinal strain (TLS), the global longitudinal strain (GLS) of the three myocardial layers, and the global circumferential strain (GCS) were calculated based on the perfusion region of the three coronary arteries and the 17-segment model of the left ventricle. The primary endopoints were TLS and GCS of the three-layer myocardium.

Compared with the nonsignificant CAD patients, the TLS and GCS of three-layer myocardium in significant CAD patients were decreased, especially in the endocardium. The absolute values of TLS and GCS of the endocardium and epicardium in significant CAD patients were lower than those in nonsignificant CAD patients. This indicates a significant decrease in endocardial function. Receiver operating characteristic (ROC) curve analysis showed that endocardial TLS was superior to LVEF, Troponin I (TnI), and other strain parameters in evaluating the extent of coronary lesions.

The layered strain technique of 2D-STE can evaluate the severity of coronary lesions in patients with NSTE-ACS, and for significant CAD patients, endocardial function is significantly more impaired than epicardial function.