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Identification of high-risk patients with non-ST segment elevation acute coronary syndromes using strain analysis
Session:
Posters (Sessão 4 - Écran 1) - Imagem 2 - Ecocardiografia 1
Speaker:
Diana De Campos
Congress:
CPC 2022
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Diana Decampos; João Lopes; Carolina Saleiro; José Pedro Sousa; Ana Rita m. Gomes; Rogério Teixeira; Ana Botelho; Lino Gonçalves
Abstract
<p>Background: Patients with acute coronary occlusion may lack typical signs of myocardial infarction in the electrocardiogram. Our aim was to evaluate global longitudinal strain (GLS) in patients with left anterior descending coronary artery (LAD) significant stenosis (>90%).</p> <p>Methods: In a retrospective study, consecutive patients admitted for an non-ST-elevation acute coronary syndrome (NSTE-ACS) were categorized into two groups: (1) those with LAD > 90% stenosis and (2) those without. Those in group 2 had either significant or non-significant coronary artery disease in other territories. Two-dimensional speckle tracking was performed using a semi-automatic algorithm (EchoPac, GE Healthcare). Longitudinal strain curves were generated in a 18-segment model. The association between GLS as predictor of an acute LAD lesion was assessed by linear regression models. Receiver operating characteristic (ROC) curves were used to analyze the ability of GLS to predict significant LAD stenosis.</p> <p>Results: A total of106 patients aged 57±12 years and 78.2% male were enrolled. A significant LAD stenosis was present in 31.8% of the patients. About half (45.3%) had previous history of CAD and only 17% had previous heart failure. Patients had a mean left ventricular ejection fraction of 49.4±9.8% and an average LV-GLS of -16±4%. LV-GLS was significantly lower in patients with an acute lesion of the LAD (-14.8±3.7% vs -16.7±4%, <em>P</em>=0.035). A LV-GLS > -15.1% yielded an area under the curve (AUC) of 0.64 (95% CI 0.53 to 0.74) for predicting LAD lesion >90%. Both GLS-2C and apical GLS were independent predictors of obstructive LAD lesion by multivariate logistic regression. ROC analysis demonstrated that a GLS-2C > -17% exhibited a good ability to identify patients with significant LAD lesion (AUC 0.67, 95% 0.56-0.77, sensitivity of 78% and a specificity of 52%). An apical GLS > -12.5% yielded a sensitivity of 50% and a specificity of 98% for predicting a significant LAD stenosis (AUC of 0.75, 95% CI 0.64 to 0.84). These associations were independent of the site of LAD occlusion.</p> <p>Conclusion: In NSTE-ACS patients, GLS analysis detected LAD lesion >90%. Patients with GLS-2C >17% and apical GLS > -12.5% have a high probability of having an obstructive LAD lesion. This study warrants further research exploring LV-GLS as a tool in the early risk assessment in patients with an ACS.</p> <p>Figure 1. Receiver operating characteristic analysis to identify LAD lesion >90% in non-ST-elevation acute coronary syndrome patients.</p>
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