Reduced regional strain rate is the most accurate dysfunction in predicting culprit lesions in patients with acute coronary syndrome

Rafik B Shenouda; Ibadete Bytyçi; Mohammed Sobhy; Michael Y Henein

doi:10.1111/cpf.12597

Reduced regional strain rate is the most accurate dysfunction in predicting culprit lesions in patients with acute coronary syndrome

Clin Physiol Funct Imaging. 2020 Jan;40(1):21-29. doi: 10.1111/cpf.12597. Epub 2019 Oct 23.

Authors

Rafik B Shenouda^{1

2}, Ibadete Bytyçi^{2

3}, Mohammed Sobhy^{1

4}, Michael Y Henein^{2

5

6}

Affiliations

¹ International Cardiac Centre, Alexandria, Egypt.
² Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
³ Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Albania.
⁴ Cardiology Department, Alexandria University, Alexandria, Egypt.
⁵ Molecular and Clinic Research Institute, St George University, London, UK.
⁶ Brunel University, Uxbridge, UK.

PMID: 31549763
DOI: 10.1111/cpf.12597

Abstract

Background and aim: Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS.

Methods: In 80 consecutive patients with ACS (age 55·7 ± 9·4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention.

Results: Of the 80 patients, one-vessel stenosis (>70%) was present in 53 (66%), two-vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending - LAD (r = 0·35, P = 0·005), circumflex LCx (r = 0·32, P = 0·03) and right coronary RCA (r = 0·37, P = 0·01). Only ECG changes in the LAD territory (r = 0·26, P = 0·04) correlated with the culprit lesion. SR of LAD territories ≤-0·74 was 71% sensitive and 70% specific (AUC = 0·70, CI = 0·67-0·93, P = 0·01), SR of LCx territories of ≤-0·67 was 75% sensitive and 63% specific (AUC = 0·72, CI = 0·58-0·87, P = 0·02) and SR of RCA territories ≤-0·83 was 73% sensitive and 71% specific (AUC = 0·80, CI = 0·66-0·93, P = 0·001) in predicting significant stenosis. SR was more accurate than all other techniques in predicting the culprit lesion.

Conclusion: In ACS, mean regional speckle tracking SR is more sensitive than peak strain, TDI, ECG changes and wall motion abnormalities in detecting significant coronary artery stenosis.

Keywords: acute coronary syndrome; culprit lesion; echocardiography; myocardial strain imaging.

MeSH terms

Acute Coronary Syndrome / diagnosis*
Acute Coronary Syndrome / physiopathology*
Echocardiography / methods*
Female
Heart Ventricles / physiopathology*
Humans
Male
Middle Aged
Reproducibility of Results