title: Multilayer longitudinal strain at rest may help to predict significant stenosis of the left anterior descending coronary artery in patients with suspected non-ST-elevation acute coronary syndrome.
abstract: Two-dimensional speckle tracking echocardiography (2D-STE) multilayer analysis of myocardial deformation is a non-invasive method that enables discrimination of transmural differences owing to myocardial ischemia or necrosis. We wished to ascertain if multilayer longitudinal strains at rest are associated with significant (≥70 %) stenosis of the left anterior descending coronary artery (LAD) in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS). Our cohort comprised 113 consecutive patients with suspected NSTE-ACS and preserved ejection fraction (EF). Using coronary angiography, we diagnosed 63 patients with significant stenosis of the LAD and 50 patients without significant coronary artery disease. Echocardiography was done ≤48 h before angiography. Multilayer longitudinal strains were assessed from the endocardium, mid-myocardium and epicardium by 2D-STE. Regional longitudinal strain in LAD territory (RLSLAD) was calculated as the mean peak systolic longitudinal strain of segments subtended by the LAD for all myocardial layers. Significant differences were observed in all strain parameters between the two groups. RLSLADand global longitudinal strain in the endocardium showed higher accuracy than that in the mid-myocardium and epicardium, wall motion score index (WMSI), WMSI in LAD territory, and EF for detection of significant LAD stenosis (all P < 0.05), with areas under the receiver operating characteristic curve of 0.87 and 0.91, respectively. An endocardial RLSLADcutoff of -23.52 % showed optimal sensitivity and specificity (88.9/80.0 %). In patients with suspected NSTE-ACS, multilayer longitudinal strain analysis at rest might enable prediction of significant LAD stenosis, and could help to identify patients requiring reperfusion.
authors: Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, No. 148, Baojian Road, Nangang District, Harbin, 150086, China.
authors: Chong
authors: C
authors: Liu
authors: Department of Ultrasound, First Hospital of Qiqihar City, No. 30, Gongyuan Road, Longsha District, Qiqihar, 161005, China.
authors: Jing
authors: J
authors: Li
authors: Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, No. 148, Baojian Road, Nangang District, Harbin, 150086, China.
authors: Min
authors: M
authors: Ren
authors: Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, No. 148, Baojian Road, Nangang District, Harbin, 150086, China.
authors: Zhen-Zhen
authors: ZZ
authors: Wang
authors: Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, No. 148, Baojian Road, Nangang District, Harbin, 150086, China.
authors: Zi-Yao
authors: ZY
authors: Li
authors: Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, No. 148, Baojian Road, Nangang District, Harbin, 150086, China.
authors: Fei
authors: F
authors: Gao
authors: Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, No. 148, Baojian Road, Nangang District, Harbin, 150086, China. jwtian2004@163.com.
authors: Jia-Wei
authors: http://orcid.org/0000-0002-4458-4795
authors: JW
authors: Tian
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000368:Aged; D019540:Area Under Curve; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left
keywords: Acute coronary syndrome; Echocardiography; Left anterior descending coronary artery; Longitudinal strain; Myocardial layers; Speckle tracking