Key result
In patients with NSTEMI, acute coronary occlusion was associated with larger infarct size (13% vs 3%, p<0.001) and could be accurately identified early using territorial circumferential strain (AUC 0.93).
Why the study?
Does myocardial strain by speckle-tracking echocardiography accurately identify acute coronary occlusions in patients with suspected NSTE-ACS?
Observational (n=111)
Does myocardial strain by speckle-tracking echocardiography accurately identify acute coronary occlusions in patients with suspected NSTE-ACS?
Territorial circumferential strain by echocardiography can accurately identify acute coronary occlusions in NSTE-ACS patients, enabling early detection of those who may require urgent revascularization.
May support strain imaging to flag occlusions in NSTE-ACS; hypothesis-generating and requires prospective validation before practice change.
OBJECTIVES: To compare infarct size and left ventricular ejection fraction in patients with non-ST-elevation myocardial infarction (NSTEMI) with and without acute coronary occlusions, and determine if myocardial strain by speckle-tracking echocardiography can identify acute occlusions in patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: 111 patients with suspected NSTE-ACS were enrolled shortly after admittance. Echocardiographic measurements were performed a median of 1 h (interquartile range 0.5-4) after admittance, and coronary angiography 36 ± 21 h after onset of symptoms. Territorial longitudinal and circumferential strain was calculated based on the perfusion territories of the three major coronary arteries in a 16-segment model of the left ventricle, and compared with traditional echocardiographic parameters. Long-term follow-up was by echocardiography and contrast-enhanced magnetic resonance imaging (ceMRI). RESULTS: Patients with NSTEMI due to acute coronary occlusion had higher peak troponin T than patients with NSTEMI without acute occlusions (4.9 ± 4.7 vs 0.9 ± 1.1 μg/l, p<0.001), larger infarct size by ceMRI (13 ± 8% vs 3 ± 3%, p<0.001) and poorer left ventricular ejection fraction (48 ± 6% vs 57 ± 6%, p<0.001) at follow-up. Territorial circumferential strain was the best parameter for predicting acute coronary occlusion. A territorial circumferential strain value >-10.0% had 90% sensitivity, 88% specificity and area under the curve=0.93 for identification of acute occlusions. CONCLUSIONS: Patients with NSTEMI due to acute coronary occlusions develop larger infarcts and more impaired left ventricular function than patients with NSTEMI without occlusions, regardless of infarct-related territory. Territorial circumferential strain by echocardiography enables very early identification of acute coronary occlusions in patients with NSTE-ACS and may be used for detection of patients requiring urgent revascularisation.
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Grenne et al. (2010) conducted an observational in suspected NSTE-ACS (n=111). Acute coronary occlusion vs. No acute coronary occlusion was evaluated on Infarct size by ceMRI at follow-up (p=<0.001). In patients with NSTEMI, acute coronary occlusion was associated with larger infarct size (13% vs 3%, p<0.001) and could be accurately identified early using territorial circumferential strain (AUC 0.93).
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