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Comment
. 2022 Feb 25;2(2):oeac010.
doi: 10.1093/ehjopen/oeac010. eCollection 2022 Mar.

Coronary-specific quantification of myocardial deformation by strain echocardiography may disclose the culprit vessel in patients with non-ST-segment elevation acute coronary syndrome

Andrea Igoren Guaricci  1 , Giuseppina Chiarello  1 , Elisa Gherbesi  2 , Laura Fusini  3 , Nicolo' Soldato  1 , Paola Siena  1 , Raffaella Ursi  1 , Roberta Ruggieri  1 , Marco Guglielmo  3 , Giuseppe Muscogiuri  3 , Andrea Baggiano  3 , Mark G Rabbat  4 , Riccardo Memeo  1 , Mario Lepera  1 , Stefano Favale  1 , Gianluca Pontone  3
Affiliations
Comment

Coronary-specific quantification of myocardial deformation by strain echocardiography may disclose the culprit vessel in patients with non-ST-segment elevation acute coronary syndrome

Andrea Igoren Guaricci et al. Eur Heart J Open. .

Abstract

Aims: To compare the diagnostic accuracy of speckle tracking echocardiography technique using territorial longitudinal strain (TLS) for the detection of culprit vessel vs. vessel-specific wall motion score index (WMSI) in non-ST-segment elevation-acute coronary syndrome (NSTE-ACS) patients scheduled for invasive coronary angiography (ICA).

Methods and results: One hundred and eighty-three patients (mean age: 66 ± 12 years, male: 71%) diagnosed with NSTE-ACS underwent echocardiography evaluation at hospital admission and ICA within 24 h. Culprit vessels were left anterior descending (LAD), left circumflex (CX), and right coronary arteries (RCAs) in 38.5%, 39.6%, and 21.4%, respectively. An increase of affected vessels [1-, 2-, and 3-vessel coronary artery disease (CAD)] was associated with increased WMSI and TLS values. There was a statistically significant difference of both WMSI-LAD, WMSI-CX, WMSI-RCA and TLS-LAD, TLS-CX, TLS-RCA of myocardial segments with underlying severe CAD compared to no CAD (P = 0.001 and P < 0.001, respectively). Moreover, a significant difference of TLS-LAD, TLS-CX, TLS-RCA, and WMSI-CX of myocardial segments with an underlying culprit vessel compared to non-culprit vessels (P < 0.001, P < 0.001, P = 0.022, and P < 0.001, respectively) was identified. WMSI-LAD and WMSI-RCA did not show statistical significant differences. A regression model revealed that the combination of WMSI + TLS was more accurate compared to WMSI alone in detecting the culprit vessel (LAD, P = 0.001; CX, P < 0.001; and RCA, P = 0.019).

Conclusion: Territorial longitudinal strain allows an accurate identification of the culprit vessel in NSTE-ACS patients. In addition to WMSI, TLS may be considered as part of routine echocardiography for better clinical assessment in this subset of patients.

Keywords: 2D speckle tracking echocardiography; Culprit lesion; Non-ST-elevation myocardial infarction; Territorial longitudinal strain.

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Figures

Figure 1
Figure 1
Territorial longitudinal strain model. This figure shows the segmental peak systolic strain values within each coronary-specific territory.
Figure 2
Figure 2
Box plots of territorial longitudinal strain. This figure shows the discriminatory strength of the territorial longitudinal strain. TLS-CX, territorial longitudinal strain-left circumflex artery; TLS-LAD, territorial longitudinal strain-left anterior descending; TLS-RCA, territorial longitudinal strain-right coronary artery.
Figure 3
Figure 3
Predictive models of culprit vessel. Incremental value of wall motion score index + territorial longitudinal strain in predicting the culprit vessel when compared with a model including wall motion score index alone for each vessel.
None
See this image and copyright information in PMC

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References

    1. Roger VL, Weston SA, Gerber Y, Killian JM, Dunlay SM, Jaffe AS, Bell MR, Kors J, Yawn BP, Jacobsen SJ.. Trends in incidence, severity, and outcome of hospitalized myocardial infarction. Circulation 2010;121:863–869. - PMC - PubMed
    1. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation 2018;137:e67–e492. - PubMed
    1. Boeddinghaus J, Nestelberger T, Twerenbold R, Neumann JT, Lindahl B, Giannitsis E, Sörensen NA, Badertscher P, Jann JE, Wussler D, Puelacher C, Rubini Giménez M, Wildi K, Strebel I, Du Fay de Lavallaz J, Selman F, Sabti Z, Kozhuharov N, Potlukova E, Rentsch K, Miró Ò, Martin-Sanchez FJ, Morawiec B, Parenica J, Lohrmann J, Kloos W, Buser A, Geigy N, Keller DI, Osswald S, Reichlin T, Westermann D, Blankenberg S, Mueller C; APACE, BACC, and TRAPID-AMI Investigators. Impact of age on the performance of the ESC 0/1h algorithms for early diagnosis of myocardial infarction. Eur Heart J 2018;39:3780–3794. - PubMed
    1. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM.. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021 Apr 7;42(14):1289–1367.
    1. Guaricci AI, Pontone G, Fusini L, De Luca M, Cafarelli FP, Guglielmo M, Baggiano A, Beltrama V, Muscogiuri G, Mushtaq S, Conte E, Guglielmi G, Andreini D, Brunetti ND, Di Biase M, Bartorelli AL, Pepi M.. Additional value of inflammatory biomarkers and carotid artery disease in prediction of significant coronary artery disease as assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2017;18:1049–1056. - PubMed