title: Longitudinal 2D strain can help diagnose coronary artery disease in patients with suspected non-ST-elevation acute coronary syndrome but apparent normal global and segmental systolic function.
abstract: BACKGROUND
  The clinical work-up of patients presenting with chest pain is a diagnostic challenge. We investigated the diagnostic performance of global (GLS) and territorial (TLS) longitudinal strain to predict coronary artery disease (CAD) in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) but apparent normal global and regional systolic function.
  
  
  METHODS
  150 consecutive suspected NSTE-ACS patients were initially screened for inclusion ; 58 patients with normal LVEF (≥55%) and WMSI (=1) were prospectively enrolled. Speckle-tracking echocardiography was performed on admission and all the patients underwent coronary angiography. CAD was defined as the presence of stenosis of >50%.
  
  
  RESULTS
  CAD was present in 33 patients (57%). LVEF was 60.7±4.6% in group 1 (CAD) and 61.1±5.0% in group 2 (no CAD). Global longitudinal strain (GLS) was altered in group 1 (-16.7±3.4%) as compared to group 2 (-22.4±2.9%, p<0.001). ROC curve analysis showed a high diagnostic value of GLS for the prediction of CAD (AUC=0.92 [0.84-1.00], p=0.0001). TLS was able to discriminate between coronary stenosis in the LAD, LCX or RCA.
  
  
  CONCLUSIONS
  Longitudinal 2D strain has a good diagnostic value and can efficiently localize the culprit lesion in patients presenting with NSTE-ACS but apparent normal global and regional systolic function.
authors.affiliation: Department of Cardiology, University Hospital of Strasbourg, France. Electronic address: thibault.caspar@chru-strasbourg.fr.
authors.forename: Thibault
authors.initials: T
authors.lastname: Caspar
authors.affiliation: Department of Cardiology, University Hospital of Strasbourg, France.
authors.forename: Hafida
authors.initials: H
authors.lastname: Samet
authors.affiliation: Department of Radiology, University Hospital of Strasbourg, France.
authors.forename: Mickaël
authors.initials: M
authors.lastname: Ohana
authors.affiliation: Department of Radiology, University Hospital of Strasbourg, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Germain
authors.affiliation: Department of Radiology, University Hospital of Strasbourg, France.
authors.forename: Soraya
authors.initials: S
authors.lastname: El Ghannudi
authors.affiliation: Department of Cardiology, University Hospital of Strasbourg, France.
authors.forename: Samy
authors.initials: S
authors.lastname: Talha
authors.affiliation: Department of Cardiology, University Hospital of Strasbourg, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Morel
authors.affiliation: Department of Cardiology, University Hospital of Strasbourg, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ohlmann
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D061827:Dimensional Measurement Accuracy; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D013318:Stroke Volume; D016276:Ventricular Function
keywords: Acute coronary syndrome; Chest pain diagnosis; Coronary artery disease; Speckle-tracking echocardiography; Two-dimensional strain