Coronary-specific quantification of myocardial deformation by strain echocardiography may disclose the culprit vessel in patients with non-ST-segment elevation acute coronary syndrome

Andrea Igoren Guaricci; Giuseppina Chiarello; Elisa Gherbesi; Laura Fusini; Nicolo' Soldato; Paola Siena; Raffaella Ursi; Roberta Ruggieri; Marco Guglielmo; Giuseppe Muscogiuri; Andrea Baggiano; Mark G Rabbat; Riccardo Memeo; Mario Lepera; Stefano Favale; Gianluca Pontone

doi:10.1093/ehjopen/oeac010

Coronary-specific quantification of myocardial deformation by strain echocardiography may disclose the culprit vessel in patients with non-ST-segment elevation acute coronary syndrome

Eur Heart J Open. 2022 Feb 25;2(2):oeac010. doi: 10.1093/ehjopen/oeac010. eCollection 2022 Mar.

Authors

Andrea Igoren Guaricci¹, Giuseppina Chiarello¹, Elisa Gherbesi², Laura Fusini³, Nicolo' Soldato¹, Paola Siena¹, Raffaella Ursi¹, Roberta Ruggieri¹, Marco Guglielmo³, Giuseppe Muscogiuri³, Andrea Baggiano³, Mark G Rabbat⁴, Riccardo Memeo¹, Mario Lepera¹, Stefano Favale¹, Gianluca Pontone³

Affiliations

¹ Department of Emergency and Organ Transplantation, University Cardiology Unit, Policlinic University Hospital, Piazza Giulio Cesare 11, Bari 70124, Italy.
² Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
³ Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
⁴ Loyola University of Chicago, Chicago, IL, USA.

Abstract

Aims: To compare the diagnostic accuracy of speckle tracking echocardiography technique using territorial longitudinal strain (TLS) for the detection of culprit vessel vs. vessel-specific wall motion score index (WMSI) in non-ST-segment elevation-acute coronary syndrome (NSTE-ACS) patients scheduled for invasive coronary angiography (ICA).

Methods and results: One hundred and eighty-three patients (mean age: 66 ± 12 years, male: 71%) diagnosed with NSTE-ACS underwent echocardiography evaluation at hospital admission and ICA within 24 h. Culprit vessels were left anterior descending (LAD), left circumflex (CX), and right coronary arteries (RCAs) in 38.5%, 39.6%, and 21.4%, respectively. An increase of affected vessels [1-, 2-, and 3-vessel coronary artery disease (CAD)] was associated with increased WMSI and TLS values. There was a statistically significant difference of both WMSI-LAD, WMSI-CX, WMSI-RCA and TLS-LAD, TLS-CX, TLS-RCA of myocardial segments with underlying severe CAD compared to no CAD (P = 0.001 and P < 0.001, respectively). Moreover, a significant difference of TLS-LAD, TLS-CX, TLS-RCA, and WMSI-CX of myocardial segments with an underlying culprit vessel compared to non-culprit vessels (P < 0.001, P < 0.001, P = 0.022, and P < 0.001, respectively) was identified. WMSI-LAD and WMSI-RCA did not show statistical significant differences. A regression model revealed that the combination of WMSI + TLS was more accurate compared to WMSI alone in detecting the culprit vessel (LAD, P = 0.001; CX, P < 0.001; and RCA, P = 0.019).

Conclusion: Territorial longitudinal strain allows an accurate identification of the culprit vessel in NSTE-ACS patients. In addition to WMSI, TLS may be considered as part of routine echocardiography for better clinical assessment in this subset of patients.

Keywords: 2D speckle tracking echocardiography; Culprit lesion; Non-ST-elevation myocardial infarction; Territorial longitudinal strain.

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