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Is territorial longitudinal strain able to predict the coronary artery disease culprit lesion in acute coronary syndromes?
Session:
Painel 7 - Doença Coronária 11
Speaker:
Carolina Saleiro
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Carolina Saleiro; Diana Decampos; Rogerio Teixeira; Ana Rita M. Gomes; João Lopes; José Pedro Sousa; Luís Puga; Dilma Fernandes; Joana M. Ribeiro; Marco Costa; Lino Gonçalves
Abstract
<p><strong>Background: </strong>Global Longitudinal strain (GLS) is emerging as an accurate parameter for the assessment of early left ventricular dysfunction. Like wall motion abnormalities, territorial longitudinal strain (TLS) may have a role to predict the culprit coronary artery in the setting of an acute coronary syndrome (ACS). Nevertheless, the role of TLS in this particular field is still unclear.</p> <p><strong>Aim: </strong>To assess the ability of 2D TLS to predict coronary artery culprit stenosis in ACS.</p> <p><strong>Methods: </strong>Patients admitted to a single coronary care unit with a diagnosis of ACS had their clinical, angiographic and echocardiographic data evaluated. GLS was retrospectively assessed in a single software, in a total of 85 patients. TLS was calculated for each coronary artery (left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) as the average strain in segments in the theoretical perfusion territory of the artery. The absolute TLS value |x| was used for a simpler interpretation. ROC analysis was used to determine the ability of TLS to distinguish patients with a given coronary artery significant stenosis (defined as ≥ 75% stenosis). The cut-off value to predict stenosis was derived from the Youden index.</p> <p><strong>Results</strong>: Eighty percent of the patients were male, with a mean age 65±11 years old. The majority (48%) was admitted with non-ST elevation myocardial infarction. Thirty-five had multivessel vessel disease; 54% of the patients had LAD stenosis ≥75%; 27% had LCX stenosis; and 44% had RCA stenosis. The average TLS for LAD territory was 16.4±5.2%, and the area under the curve (AUC) was 0.71 (95% CI 0.60-0.82, <em>P=0.001</em>). Mean TLS for RCA segments was 15.2±4.7% with an AUC of 0.67 (95% CI 0.55-0.79, <em>P=0.008</em>). Only TLS in LCX territory could not predict LCX stenosis, with an AUC 0.47 (95% CI 0.34-0.63, <em>P=0.85</em>). The best TLS cut point to predict LAD stenosis was −16.4% and for RCA was -13.2%. Wall motion abnormalities predicted only correctly stenosis in the LAD territory: AUC 0.70 (95% CI 0.59-0.81, <em>P=0.002</em>).</p> <p><strong>Conclusion: </strong>Territorial longitudinal strain efficiently identified the culprit lesion in the LAD and RCA but not to the LCX territories. It seems to add extra value in the acute setting, primarily by better identifying RCA lesions when compared to with wall motion abnormalities.</p> <p> </p>
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