Diagnostic potential of myocardial early systolic lengthening for patients with suspected non-ST-segment elevation acute coronary syndrome

Abstract

Abstract Background During early systole, ischemic myocardium with reduced active force experiences early systolic lengthening (ESL). This study aimed to explore the diagnostic potential of myocardial ESL in suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF). Methods Overall, 195 suspected NSTE-ACS patients with normal wall motion and LVEF, who underwent speckle tracking echocardiography (STE) before coronary angiography were included. Patients were stratified into coronary artery disease (CAD) group when there was ≥ 50% stenosis in at least one major coronary artery. CAD patients were further stratified into significant (≥ 70% reduction of vessel diameter) stenosis group and non-significant stenosis group. Myocardial strain parameters, including global longitudinal strain (GLS), duration of early systolic lengthening (DESL), early systolic index (ESI) and post-systolic index (PSI) were analyzed using STE and compared between groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic accuracy. Logistic regression analysis was conducted to establish the independent and incremental determinants for the presence of significant coronary stenosis. Results DESL and ESI were higher in patients with CAD than those without CAD. In addition, CAD patients with significant coronary stenosis had higher DESL and ESI than those without significant coronary stenosis. The ROC analysis revealed that ESI was superior to PSI in identifying patients with CAD, and further superior to GLS and PSI in predicting significant coronary stenosis. Moreover, ESI could provide independent and incremental predictive efficacy on significant coronary stenosis in patients with CAD. Conclusions Myocardial ESI is of great value for the diagnosis and risk stratification in clinically suspected NSTE-ACS patients with normal LVEF and wall motion.