Usefulness of post-systolic index in facilitating stratification of risk in patients with intermediate- or low-risk...

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Imaging

Background:

• Left ventricular global longitudinal strain (LV GLS) on 2D speckle-tracking echocardiography shows usefulness in excluding significant coronary artery disease (CAD) in low-risk non-ST-segment elevation-acute coronary syndrome (NSTE-ACS).
• The efficacy of post-systolic index (PSI) for risk stratification in NSTE-ACS patients remains largely unknown.

Purpose of the Study:

• To explore the usefulness of PSI in facilitating risk stratification for patients with intermediate- or low-risk NSTE-ACS.
• To evaluate the added value of PSI and LV GLS in predicting the need for percutaneous coronary intervention (PCI).

Main Methods:

• Echocardiographic strain analysis was performed on 43 patients with suspected intermediate- or low-risk NSTE-ACS.
• Coronary angiography (CAG) was used to diagnose CAD, and percutaneous coronary intervention (PCI) performance was recorded.
• Receiver-operator characteristic (ROC) curve analysis was used to assess the diagnostic performance of PSI and the combined use of PSI and LV GLS with the GRACE risk score.

Main Results:

• Patients with CAD exhibited significantly higher PSI compared to those without CAD (25% vs 15%, P=0.007).
• A PSI cutoff of >20% demonstrated good performance in detecting PCI, with an area under the curve (AUC) of 0.72.
• The addition of PSI and LV GLS to the GRACE risk score significantly improved the classification of PCI performance (AUC increased from 0.57 to 0.75, net reclassification improvement P=0.04).

Conclusions:

• Post-systolic index (PSI) is a valuable parameter for risk stratification in intermediate- or low-risk NSTE-ACS patients.
• Measuring PSI in routine clinical practice is recommended for improved patient management.
• The combination of PSI and LV GLS enhances the accuracy of risk assessment in NSTE-ACS.