Prediction of the Culprit Vessel using Territorial Longitudinal Strain in Non-ST-segment Elevation Myocardial Infarction.

We evaluated the role of speckle tracking derived territorial longitudinal strain (TLS) to predict the culprit artery in non-ST elevation myocardial infarction (NSTEMI). We evaluated 211 NSTEMI patients scheduled for invasive coronary angiography. Transthoracic conventional and speckle tracking echocardiography was done to assess the left ventricular systolic function, wall motion score index (WMSI), territorial WMSI, and TLS. Coronary angiography within 24 h of hospital admission was used to evaluate the culprit vessel. The culprit vessel was most commonly left anterior descending (LAD) "36.5%" and left circumflex (LCX) "35.1%" followed by right coronary (RCA) "28.4%." Multivessel disease patients had higher WMSI and lower global longitudinal strain (GLS) compared to single- and 2-vessel disease (P < 0.001). TLS was significantly lower in the culprit vessel territory than in normal and stenosed nonculprit vessels. Moreover, TLS-LCX and TLS-RCA were markedly lower in the stenosed nonculprit territory than normal vessels. Adding TLS to WMSI significantly improved the prediction of the culprit vessel (P < 0.001). TLS-LAD, TLS-LCX, and TLS-RCA were independent predictors of the culprit vessel. The optimal cutoff value of TLS-LAD, TLS-LCX, and TLS-RCA was -15.65% (96.1% sensitivity and 100% specificity), -15.65% (94.6% sensitivity and 98.5% specificity), and -16.6% (100% sensitivity and 98.7% specificity), respectively. TLS is an independent predictor for identifying the culprit vessel in patients with NSTEMI. Therefore, it should be evaluated during echocardiographic assessment of those patients.