Diagnostic potential of myocardial early systolic lengthening for patients with suspected non-ST-segment elevation acute coronary syndrome

Wanwei Zhang; Qizhe Cai; Mingming Lin; Runyu Tian; Shan Jin; Yunyun Qin; Xiuzhang Lu

doi:10.1186/s12872-023-03364-y

Diagnostic potential of myocardial early systolic lengthening for patients with suspected non-ST-segment elevation acute coronary syndrome

BMC Cardiovasc Disord. 2023 Jul 19;23(1):364. doi: 10.1186/s12872-023-03364-y.

Authors

Wanwei Zhang¹, Qizhe Cai¹, Mingming Lin¹, Runyu Tian¹, Shan Jin¹, Yunyun Qin², Xiuzhang Lu³

Affiliations

¹ Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China.
² Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China. yun_23@126.com.
³ Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China. echolxz@163.com.

Abstract

Background: During early systole, ischemic myocardium with reduced active force experiences early systolic lengthening (ESL). This study aimed to explore the diagnostic potential of myocardial ESL in suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF).

Methods: Overall, 195 suspected NSTE-ACS patients with normal wall motion and LVEF, who underwent speckle tracking echocardiography (STE) before coronary angiography, were included in this study. Patients were stratified into the coronary artery disease (CAD) group when there was ≥ 50% stenosis in at least one major coronary artery. The CAD patients were further stratified into the significant (≥ 70% reduction of vessel diameter) stenosis group or the nonsignificant stenosis group. Myocardial strain parameters, including global longitudinal strain (GLS), duration of early systolic lengthening (DESL), early systolic index (ESI), and post-systolic index (PSI), were analyzed using STE and compared between groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic accuracy. Logistic regression analysis was conducted to establish the independent and incremental determinants for the presence of significant coronary stenosis.

Results: The DESL and ESI values were higher in patients with CAD than those without CAD. In addition, CAD patients with significant coronary stenosis had higher DESL and ESI than those without significant coronary stenosis. The ROC analysis revealed that ESI was superior to PSI for identifying patients with CAD, and further superior to GLS and PSI for predicting significant coronary stenosis. Moreover, ESI could independently and incrementally predict significant coronary stenosis in patients with CAD.

Conclusions: The myocardial ESI is of great value for the diagnosis and risk stratification of clinically suspected NSTE-ACS patients with normal LVEF and wall motion.

Keywords: Deformation; Early systolic lengthening; Non-ST-segment elevation acute coronary syndrome; Speckle tracking echocardiography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome* / diagnosis
Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease*
Coronary Stenosis* / diagnostic imaging
Humans
Myocardium
Reproducibility of Results
Stroke Volume
Ventricular Function, Left