Accuracy of Myocardial Speckle Tracking in Identifying the Culprit Vessel in Non-ST-Segment Elevation Acute Coronary
Hejia Sun1, Yuze Han2, Lidong Zhu2
1China Medical University, Shenyang, China.
Insights
Speckle tracking echocardiography (STE) accurately identifies the culprit vessel in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients. This noninvasive technique provides crucial information for treatment decisions before invasive procedures.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) require accurate culprit vessel (CV) identification for timely treatment.
- Current noninvasive methods like electrocardiogram (ECG) and transthoracic echocardiography (TTE) have limitations in CV localization.
- Speckle tracking echocardiography (STE) offers a potential noninvasive solution for enhanced diagnostic accuracy.
Purpose of the Study:
- To evaluate the diagnostic efficacy of ECG, TTE, and STE in identifying the CV in NSTE-ACS patients.
- To explore the accuracy and feasibility of STE for providing CV information to guide clinical decision-making.
- To compare the performance of STE-derived parameters with traditional methods.
Main Methods:
- Retrospective analysis of 142 NSTE-ACS patients.
- Assessment of ECG, TTE-derived wall motion score index (WMSI), and STE-derived territorial longitudinal strain (TLS).
- Comparison of diagnostic accuracy before coronary angiography (CAG).
Main Results:
- STE demonstrated significantly higher accuracy (87.3%) in CV identification compared to ECG (23.2%) and TTE (47.9%).
- STE showed superior sensitivity and specificity for identifying individual coronary arteries (LAD, RCA, LCx) as the CV.
- The combined WMSI + TLS model outperformed WMSI alone, and epicardial TLS (Epi-TLS) independently predicted the CV in multivessel disease.
Conclusions:
- STE is a highly accurate noninvasive technique for identifying the CV in NSTE-ACS patients prior to CAG.
- Epi-TLS derived from STE provides valuable information for discriminating the true CV, especially in multivessel disease.
- STE offers a practical bedside diagnostic tool for NSTE-ACS patients, aiding in pre-procedural decision-making.
Purpose:
This study analyzed the diagnostic efficacy of electrocardiogram (ECG), transthoracic echocardiography (TTE), and speckle tracking echocardiography (STE) in identifying the culprit vessel (CV) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). It explored the feasibility and accuracy of the noninvasive STE technique in providing clinicians with CV-related information for treatment decision-making.
Methods:
One hundred and forty-two NSTE-ACS patients were retrospectively analyzed to evaluate the diagnostic efficacy of ECG, wall motion score index (WMSI) of TTE, and territorial longitudinal strain (TLS) of STE in identifying the CV before coronary angiography (CAG).
Results:
STE demonstrated superior accuracy (87.3%, p < 0.05) for CVs identification versus ECG (23.2%) and TTE (47.9%). The sensitivities of ECG, TTE, and STE in identifying the left anterior descending artery as the CV were 35.7%, 58.9%, and 89.3%, respectively (p < 0.05), with specificities of 88.4%, 90.7%, and 95.3%. For the right coronary artery, sensitivities were 17.5%, 35.0%, and 75.0% (p < 0.05; specificities: 93.1%, 92.1%, and 98.0%). For the left circumflex artery, sensitivities were 13.0%, 52.2%, and 95.7% (p < 0.05; specificities: 96.9%, 88.5%, and 87.5%). The WMSI + TLS model outperformed WMSI alone (p < 0.001). In multivessel disease, epicardial TLS (Epi - TLS) independently predicted the CV (p < 0.001) and surpassed other myocardial layers in diagnostic performance.
Conclusion:
This study demonstrated that STE showed superior accuracy to other noninvasive techniques in the identification of CV in NSTE-ACS patients before CAG. Epi-TLS offered unique value in discriminating the true CV among multivessel disease. STE offered practical bedside evaluation for NSTE-ACS patients before invasive procedures.
Trial Registration:
Dalian Friendship Municipal Hospital, China: CTR2500108952.
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