Influence of arterial hypertension on regional 2D strain analysis in patients with non-ST elevation acute coronary syndrome

    Authors

    Keywords

    acute coronary syndrome, arterial hypertension, regional wall motion assessment

    DOI

    https://doi.org/10.15836/ccar2018.402

    Full Text

    Background: In our previous research ( 1 ) we have shown 2D analysis of regional longitudinal peak systolic strain (LPSS) to be superior to visual assessment of regional wall motion abnormalities (RWMA) in detection of ischemia-induced loss of myocardial contractility due to non-ST elevation acute coronary syndrome (NSTE-ACS). ( 2 , 3 ) The reduction of LPSS in basal segments in patients with arterial hypertension (AH) is well documented. The aim of this study was to assess the impact AH has on the accuracy of regional analysis in predicting the localization of significant stenosis in NSTE-ACS. Methods: We performed a retrospective analysis of patients admitted to University Hospital Centre Zagreb from January 2013 till December 2015 due to NSTE-ACS. Exclusion criteria were no coronary angiography, absence of ECHO, and prior coronary artery disease. Total of 123 patients (62±12 years, 68% male) were included. 4 blinded clinicians performed regional LPSS analysis using 18-segment model, while RWMA, interpreted by clinician performing the echo, were categorized according to the wall motion score guidelines. Results: Significant correlation between flow limiting stenosis (>70% narrowing on angiography), worse RWMA and a decrease of regional LPSS in basal segments was found for all 3 coronary vessels ( Table 1 ). Patients with AH (73%) showed a lower regional LPSS and worse RWMA in all basal segments, with only lateral and posterior ones varying significantly ( Figure 1 ). However, regression analysis accounting for AH as a covariant, showed the regional changes in basal segments to be a sole result of coronary disease ( Table 2 ). AH was found to have no impact on reliability of LPSS and RWMA in predicting the localization of significant stenosis in NSTE-ACS (average method sensitivities: 59% vs 38%). Differences in 2D regional longitudinal peak systolic strain in patients with and without arterial hypertension. AH - arterial hypertension; RWMA – visual assessment of regional wall motion abnormalities; LPSS – longitudinal peak systolic strain. Conclusion: Changes in regional myocardial contractility, detected by either LPSS or RWMA, in patients with NSTE-ACS should be attributed to coronary disease irrespectively of the presence of AH.

    Cardiologia Croatica
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    Influence of arterial hypertension on regional 2D strain analysis in patients with non-ST elevation acute coronary syndrome

    Extended Abstract
    Issue11-12
    Published
    Pages402-403
    PDF via DOIhttps://doi.org/10.15836/ccar2018.402
    acute coronary syndrome
    arterial hypertension
    regional wall motion assessment

    Authors

    Mia Dubravčić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Daniel LovrićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marijan PašalićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vlatka Rešković LukšićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Kristina GašparovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dejan DošenORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jana Ljubas MačekORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Zvonimir OstojićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marija BrestovacORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jadranka Šeparović HanževačkiORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Background: In our previous research ( 1 ) we have shown 2D analysis of regional longitudinal peak systolic strain (LPSS) to be superior to visual assessment of regional wall motion abnormalities (RWMA) in detection of ischemia-induced loss of myocardial contractility due to non-ST elevation acute coronary syndrome (NSTE-ACS). ( 2 , 3 ) The reduction of LPSS in basal segments in patients with arterial hypertension (AH) is well documented. The aim of this study was to assess the impact AH has on the accuracy of regional analysis in predicting the localization of significant stenosis in NSTE-ACS. Methods: We performed a retrospective analysis of patients admitted to University Hospital Centre Zagreb from January 2013 till December 2015 due to NSTE-ACS. Exclusion criteria were no coronary angiography, absence of ECHO, and prior coronary artery disease. Total of 123 patients (62±12 years, 68% male) were included. 4 blinded clinicians performed regional LPSS analysis using 18-segment model, while RWMA, interpreted by clinician performing the echo, were categorized according to the wall motion score guidelines. Results: Significant correlation between flow limiting stenosis (>70% narrowing on angiography), worse RWMA and a decrease of regional LPSS in basal segments was found for all 3 coronary vessels ( Table 1 ). Patients with AH (73%) showed a lower regional LPSS and worse RWMA in all basal segments, with only lateral and posterior ones varying significantly ( Figure 1 ). However, regression analysis accounting for AH as a covariant, showed the regional changes in basal segments to be a sole result of coronary disease ( Table 2 ). AH was found to have no impact on reliability of LPSS and RWMA in predicting the localization of significant stenosis in NSTE-ACS (average method sensitivities: 59% vs 38%). Differences in 2D regional longitudinal peak systolic strain in patients with and without arterial hypertension. AH - arterial hypertension; RWMA – visual assessment of regional wall motion abnormalities; LPSS – longitudinal peak systolic strain. Conclusion: Changes in regional myocardial contractility, detected by either LPSS or RWMA, in patients with NSTE-ACS should be attributed to coronary disease irrespectively of the presence of AH.