Early Assessment of Strain Echocardiography Can Accurately Exclude Significant Coronary Artery Stenosis in Suspected Non–ST-Segment Elevation Acute Coronary Syndrome

• Published in: Journal of the American Society of Echocardiography Vol. 27; no. 5; pp. 512 - 519
• Main Authors: Dahlslett, Thomas, MD, Karlsen, Sigve, MD, Grenne, Bjørnar, MD, PhD, Eek, Christian, MD, PhD, Sjøli, Benthe, MD, PhD, Skulstad, Helge, MD, PhD, Smiseth, Otto A., MD, PhD, Edvardsen, Thor, MD, PhD, Brunvand, Harald, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-05-2014
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnostic imaging; Cardiovascular; Coronary Stenosis - complications; Coronary Stenosis - diagnostic imaging; Diagnosis, Differential; Early Diagnosis; Echocardiography; Echocardiography - methods; Elasticity Imaging Techniques - methods; Emergency department; Female; Humans; Image Interpretation, Computer-Assisted - methods; Male; Middle Aged; Myocardial strain; Reproducibility of Results; Sensitivity and Specificity; Speckle-tracking; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Electrocardiographic; Emergency room; Echocardiography; NSTE-ACS; WMSI; Myocardial strain; Global Registry of Acute Coronary Events; Left ventricular; ROC; ECG; LVEF; LV; Non–ST-segment elevation acute coronary syndrome; ER; Emergency department; Receiver operating characteristic; GRACE; Left ventricular ejection fraction; Speckle-tracking; cTnT; Wall motion score index; Acute coronary syndrome; Cardiac troponin T
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2014.01.019

Background Many patients with suspected non–ST-segment elevation acute coronary syndrome (NSTE-ACS) do not have significant coronary artery disease. The current diagnostic approach of repeated electrocardiography and cardiac biomarker assessment requires observation for >6 to 12 hours. This strategy places a heavy burden on hospital facilities. The objective of this study was to investigate whether myocardial strain assessment by echocardiography could exclude significant coronary artery stenosis in patients presenting with suspected NSTE-ACS. Methods Sixty-four patients presenting to the emergency department with suspected NSTE-ACS without known coronary artery disease, inconclusive electrocardiographic findings, and normal cardiac biomarkers at arrival were enrolled. Twelve-lead electrocardiography, troponin T assay, and echocardiography were performed at arrival, and all patients underwent coronary angiography. Significant coronary stenosis was defined as >50% luminal narrowing. Global myocardial peak systolic longitudinal strain was measured using speckle-tracking echocardiography. Left ventricular ejection fraction and wall motion score index were calculated. Results No significant stenosis in any coronary artery was found in 35 patients (55%). Global peak systolic longitudinal strain was superior to conventional echocardiographic parameters in distinguishing patients with and without significant coronary artery stenosis (area under the curve, 0.87). Sensitivity and specificity were calculated as 0.93 and 0.78, respectively, and positive predictive value and negative predictive value as 0.74 and 0.92, respectively. Feasibility of the strain measurements was excellent, with 97% of segments analyzed. Conclusions Myocardial strain by echocardiography may facilitate the exclusion of significant coronary artery stenosis among patients presenting with suspected NSTE-ACS with inconclusive electrocardiographic findings and normal cardiac biomarkers.