Authors

• Daniel Lovrić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-5052-6559
• Kristina Gašparović — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-1191-4831
• Vlatka Rešković Lukšić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4721-3236
• Marijan Pašalić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-3197-2190
• Dejan Došen — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-2641-4768
• Jana Ljubas Maček — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-7171-2206
• Zvonimir Ostojić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-1762-9270
• Marija Brestovac — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-1542-2890
• Jadranka Šeparović Hanževački — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-3437-6407

Keywords

regional wall motion assessment, acute coronary syndrome, coronary stenosis localization, regional 2D strain

DOI

Full Text

**Background:** Visual assessment of regional wall motion abnormalities (RWMA) on echocardiography represents the current standard in assessing the impact of coronary artery disease (CAD) induced changes in myocardial contractility. Although it has been proven to predict long-term outcomes it has been hard to rely on in acute situations due to the patient dependent variance in image acquisition quality and interoperator variability. (1-4) We hypothesized that regional 2DS assessment due to the evaluation of longitudinal shortening that is barely visible to the naked eye could potentially be more sensitive than visual RWMA assessment in detecting ischemia induced loss of contractility in non-ST elevation acute coronary syndrome (NSTE-ACS). **Methods:** We performed a retrospective analysis of patients admitted through our Emergency Room to the Cardiology Department from January 2013 till December 2015 with the diagnosis of NSTE-ACS. Patients who did not undergo coronary angiography, patients with known prior coronary artery disease and patients who did not receive an echo in the 24 hours prior to angiography were excluded, as were the patients with images not adequate for 2D strain analysis. A total of 123 patients fulfilled the criteria and were included in the analysis and 4 different clinicians blinded to laboratory and ECG results performed 2DS analysis of global and regional 2D longitudinal peak systolic strain (LPSS) according to the 18-segment model prior to coronary angiography. Regional wall motion abnormalities (RWMA) as interpreted by the clinician performing the original echo exam were categorized according to the wall motion score guidelines. **Results:** RWMA assessment shows good predictive power of coronary artery stenosis location in LAD and LCx, but not in RCA (**Table 1**). However, LPSS was significantly more precise overall (mean sensitivity 75.6% vs 39.5%, P<0.001). Statistically significant difference was present even after accounting for potentially confounding factors like arterial hypertension, smoking, alcohol, atrial fibrillation, valvular disease, age or prior medical therapy. ### Table 1: Regional visual wall motion assessment 2D longitudinal peak systolic strain values according to segments and location of coronary stenosis. | Segment | Lession location | *P* | | --- | --- | --- | | APLAX Basal anteroseptum | LAD | 0.098 | | APLAX Mid anteroseptum | LAD | <0.0001 | | APLAX Apical anteroseptum | LAD | <0.0001 | | APLAX Apical inferolateral | LCx | <0.0001 | | APLAX Mid inferolateral | LCx | 0.04 | | APLAX Basal inferolateral | LCx | 0.01 | | A4C Basal inferoseptal | RCA | 0.087 | | A4C Mid inferoseptal | LAD | 0.1 | | A4C Apical inferoseptal | LAD | <0.0001 | | A4C Apical anterolateral | LAD | 0.003 | | A4C Mid anterolateral | LCx | 0.366 | | A4C Basal anterolateral | LCx | 0.015 | | A2C Basal inferior | RCA | 0.133 | | A2C Mid inferior | RCA | 0.722 | | A2C Apical inferior | LAD | 0.15 | | A2C Apical anterior | LAD | <0.0001 | | A2C Mid anterior | LAD | 0.027 | | A2C Basal anterior | LAD | 0.032 | [†] LAD = left anterior descending coronary artery; LCx = left circumflex coronary artery; RCA = right coronary artery; APLAX = Apical long axis view; A4C = Apical four chamber view; A2C = Apical two chamber view. **Conclusion:** We have shown that a decrease in LPSS is significantly more accurate in detecting ischemia-induced loss of myocardial contractility than the visual assessment of RWMA in patients with NSTE-ACS. Our findings imply that 2DS should be employed as a supplementary tool during the echo assessment of patients with NSTE-ACS.

Literature

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