title: Early systolic lengthening may identify minimal myocardial damage in patients with non-ST-elevation acute coronary syndrome.
abstract: OBJECTIVE
  Ischaemic myocardial segments tend to stretch as the intraventricular pressure rises steeply during the isovolemic contraction phase, before they contract during ejection. We hypothesized that the time they remain stretched, called duration of early systolic lengthening (DESL), correlates with final infarct size as defined by contrast enhanced magnetic resonance imaging (CE-MRI). We also assessed whether DESL could identify patients with acute coronary occlusion, and compared it with traditional measures for myocardial function.
  
  
  RESULTS
  In this retrospective study, 150 consecutive patients with Non-ST-elevation acute coronary syndrome (NSTE-ACS) referred for coronary angiography were included. Speckle tracking echocardiography was performed prior to angiography to determine DESL. The final infarct size was quantified at follow-up 9 ± 3 months after initial admission in 61 patients and echocardiography performed in 143 patients. DESL showed good correlation with the final infarct size (r = 0.67, P < 0.001). Thirteen patients had no visible sign of infarct on CE-MRI (minimal myocardial damage), and DESL was significantly shorter in these patients than in patients with signs of infarct (27 ± 19 vs. 84 ± 41 ms, P < 0.001). Compared with left ventricular ejection fraction, wall motion score index, and global longitudinal strain, DESL showed the best accuracy in detecting patients with minimal myocardial damage, with an area under the receiver operating characteristic curve of 0.92 (0.82 to 0.99, P < 0.001). DESL was more prolonged in patients with coronary occlusions, compared with those without occlusions (86 ± 45 vs. 63 ± 31 ms, P < 0.01). DESL was significantly shorter at follow-up, compared with baseline (P = 0.04).
  
  
  CONCLUSIONS
  DESL could identify patients with minimal myocardial damage, differentiate between occlusion and non-occlusion, and may be helpful in the risk stratification of patients with NSTE-ACS.
authors.affiliation: Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway The Intervention Center, Oslo University Hospital, Oslo, Norway University of Oslo, Oslo, Norway.
authors.forename: Wasim
authors.initials: W
authors.lastname: Zahid
authors.affiliation: Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.
authors.forename: Christian Hesbø
authors.initials: CH
authors.lastname: Eek
authors.affiliation: The Intervention Center, Oslo University Hospital, Oslo, Norway KG Jebsen Cardiac, Research Center, Oslo, Norway.
authors.forename: Espen W
authors.initials: EW
authors.lastname: Remme
authors.affiliation: Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.
authors.forename: Helge
authors.initials: H
authors.lastname: Skulstad
authors.affiliation: The Intervention Center, Oslo University Hospital, Oslo, Norway University of Oslo, Oslo, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
authors.affiliation: Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway University of Oslo, Oslo, Norway thor.edvardsen@medisin.uio.no.
authors.forename: Thor
authors.initials: T
authors.lastname: Edvardsen
mesh_terms: D054058:Acute Coronary Syndrome / Q000473:pathology*; D003287:Contrast Media; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000473:pathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013599:Systole
chemical_list: D003287:Contrast Media
keywords: echocardiography; magnetic resonance imaging; myocardial infarction