Reduced regional strain rate is the most accurate dysfunction in predicting culprit lesions in patients with acute coronary syndrome

Abstract

Background and Aim Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS. Methods In 80 consecutive patients with ACS (age 55Á7 AE 9Á4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention. Results Of the 80 patients, one-vessel stenosis (>70%) was present in 53 (66%), two-vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending -LAD (r = 0Á35, P = 0Á005), circumflex LCx (r = 0Á32, P = 0Á03) and right coronary RCA (r = 0Á37, P = 0Á01). Only ECG changes in the LAD territory (r = 0Á26, P = 0Á04) correlated with the culprit lesion. SR of LAD territories ≤À0Á74 was 71% sensitive and 70% specific (AUC = 0Á70, CI = 0Á67-0Á93, P = 0Á01), SR of LCx territories of ≤À0Á67 was 75% sensitive and 63% specific (AUC = 0Á72, CI = 0Á58-0Á87, P = 0Á02) and SR of RCA territories ≤À0Á83 was 73% sensitive and 71% specific (AUC = 0Á80, CI = 0Á66-0Á93, P = 0Á001) in predicting significant stenosis. SR was more accurate than all other techniques in predicting the culprit lesion. Conclusion In ACS, mean regional speckle tracking SR is more sensitive than peak strain, TDI, ECG changes and wall motion abnormalities in detecting significant coronary artery stenosis.

The diagnostic accuracy of two-dimensional strain imaging echocardiography to detect the severity of coronary artery disease in non-ST segment elevation acute coronary syndrome

“… 28 In a study of 80 consecutive ACS patients by Shenouda et al, the mean regional systolic strain rate accurately predicted the culprit lesion. 29 Although in our study, the diagnostic accuracy was low [AUC 0.645 (CI 0.496 to 0.777); P = 0.07], the systolic strain rate was significantly different between group A and group B and correlated significantly with the syntax score.…”

Strain Rate Changes during Stress Echocardiography Are the Most Accurate Predictors of Significant Coronary Artery Disease in Patients with Previously Treated Acute Coronary Syndrome

“…Data interpretation: Although the wall motion score index is currently used as the conventional echocardiographic parameter for diagnosing ischemic dysfunction [25] and for diagnosing significant coronary artery stenosis (>70%) according to guidelines [26], it proved less accurate in the subset of patients we studied compared to myocardial deformation measurements. All our patients had symptoms suggestive of ischemia, probably stable angina, but we used stress echocardiography on them in order to identify the most accurate echocardiographic parameter for predicting the culprit lesion and whether they are the same as we previously found in patients with acute coronary syndrome (STEMI and NSTEMI) [27,28]. This objective was also strengthened by the underlying ischemic myocardial disease our patients had, as manifested by a reduced resting LV EF.…”

Myocardial deformation imaging in anesthesia and perioperative medicine: a non systematic review

“…SR has potential advantages over strain. It is less influenced by the loading conditions, has a better ability to identify the culprit lesion during acute coronary syndrome (15) and better predicts prolonged hospital stay after aortic valve replacement (16). However, major limitations still preclude its widespread use in clinical practice.…”