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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Echocardiographic speckle tracking as a tool for detecting acute total occlusion in non-ST-elevation myocardial
Manoj Kumar Rohit1, Bhupendra Kumar Sihag1, Pruthvi C Revaiah1
1Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Speckle tracking echocardiography can identify acute total coronary artery occlusion in Non-ST-elevation myocardial infarction (NSTEMI) patients. The lowest recorded mean territorial longitudinal strain (LS) effectively detects this occlusion, offering a new diagnostic approach.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Non-ST-elevation myocardial infarction (NSTEMI) is typically linked to partial or temporary artery blockages.
- Electrocardiogram (ECG) has limited accuracy in detecting acute total occlusions in NSTEMI patients.
- Speckle tracking echocardiography (STE) indices may offer early detection of coronary artery occlusion in NSTEMI.
Purpose of the Study:
- To evaluate the efficacy of STE-derived indices as early indicators of acute total coronary artery occlusion in NSTEMI patients.
- To compare STE findings between NSTEMI patients with and without acute total occlusion.
Main Methods:
- A case-control study involving 47 hemodynamically stable NSTEMI patients who underwent echocardiography and coronary angiography.
- Patients were categorized into acute occlusion and non-occlusion groups.
- Reproducibility of STE parameters was assessed in a separate cohort of 22 patients.
Main Results:
- Left-ventricular global longitudinal strain (GLS) did not significantly differ between groups.
- Median longitudinal strain (LS) in the culprit artery territory was significantly lower in the acute occlusion group (p=0.003).
- The lowest recorded mean territorial LS (LRMT LS) was significantly lower in the acute occlusion group (p=0.04), with a cut-off of 10.7 showing 70.8% sensitivity and 70% specificity for detecting acute total occlusion.
Conclusions:
- The lowest recorded mean territorial LS in NSTEMI patients demonstrates promising sensitivity and specificity for detecting acute total coronary artery occlusion.
- STE offers a potential non-invasive tool for identifying acute total occlusions in NSTEMI.
Background:
Non-ST-elevation myocardial infarction (NSTEMI) is conventionally attributed to subtotal or transient occlusion. ECG is crucial but has limited sensitivity for detecting acute total occlusion in patients with NSTEMI. We propose that speckle tracking echocardiography-derived indices serve as early indicators of coronary artery occlusion in NSTEMI.
Methods:
In this case-control study, 47 patients with first-time hemodynamically stable NSTEMI were enrolled and underwent echocardiography and coronary angiography. Patients were divided into acute occlusion and non-occlusion groups for analysis. Reproducibility analysis was done in a separate cohort of 22 patients with each patient undergoing three sets of strain echocardiography analysis: twice by the principal observer on two different instances (for intra-observer reproducibility) and once by second observer on the first instance (for inter-observer reproducibility).
Results:
The study included 24 cases (patients with acute total occlusion) and 23 controls (patients without acute total occlusion). There was no difference between the two groups in relation to baseline characteristics. Left-ventricular global longitudinal strain (GLS) did not differ significantly between the two groups. Median longitudinal strain (LS) of the culprit artery territory was significantly lower in the cases group [8.1(7.1-12.6) vs 11.6(10.9-14.1), and p = 0.003]. The lowest recorded mean territorial (LRMT) LS of any territory in a given patient was significantly lower in the cases group compared to the control group [8.1(6.7-12.1) vs. 11(10.2-13), p = 0.04). The receiver-operator curve of LRMT LS showed an area under the curve of 0.74. A cut-off value 10.7 for LRMT LS had a sensitivity of 70.8% and specificity of 70% in detecting acute total occlusion. Reproducibility analysis of GLS and territorial strain (each territory separately) showed moderate-to-good [interclass correlation coefficient (ICC)) of ≥ 0.5] inter-observer and intra-observer reproducibility in most of parameters except in territorial strain of left circumflex artery territory which showed poor intra-observer reproducibility (ICC of 0.49).
Conclusion:
The lowest recorded mean territorial LS in patients with NSTEMI showed promising sensitivity and specificity in detecting acute total occlusion.
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