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Acute coronary occlusion in non-ST-elevation acute coronary syndrome: outcome and early identification by strain echocardiography
  1. Bjørnar Grenne1,
  2. Christian Eek2,
  3. Benthe Sjøli1,
  4. Thomas Dahlslett1,
  5. Michael Uchto3,
  6. Per K Hol4,
  7. Helge Skulstad5,
  8. Otto A Smiseth2,
  9. Thor Edvardsen2,
  10. Harald Brunvand3
  1. 1Department of Medicine, Sørlandet Hospital, Arendal and University of Oslo, Oslo, Norway
  2. 2Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
  3. 3Department of Medicine, Sørlandet Hospital, Arendal, Norway
  4. 4Interventional Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  5. 5Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  1. Correspondence to Dr Harald Brunvand, Department of Medicine, Sørlandet Hospital, Arendal 4809, Norway; harald.brunvand{at}sshf.no

Abstract

Objectives To compare infarct size and left ventricular ejection fraction in patients with non-ST-elevation myocardial infarction (NSTEMI) with and without acute coronary occlusions, and determine if myocardial strain by speckle-tracking echocardiography can identify acute occlusions in patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS).

Methods 111 patients with suspected NSTE-ACS were enrolled shortly after admittance. Echocardiographic measurements were performed a median of 1 h (interquartile range 0.5–4) after admittance, and coronary angiography 36±21 h after onset of symptoms. Territorial longitudinal and circumferential strain was calculated based on the perfusion territories of the three major coronary arteries in a 16-segment model of the left ventricle, and compared with traditional echocardiographic parameters. Long-term follow-up was by echocardiography and contrast-enhanced magnetic resonance imaging (ceMRI).

Results Patients with NSTEMI due to acute coronary occlusion had higher peak troponin T than patients with NSTEMI without acute occlusions (4.9±4.7 vs 0.9±1.1 μg/l, p<0.001), larger infarct size by ceMRI (13±8% vs 3±3%, p<0.001) and poorer left ventricular ejection fraction (48±6% vs 57±6%, p<0.001) at follow-up. Territorial circumferential strain was the best parameter for predicting acute coronary occlusion. A territorial circumferential strain value >−10.0% had 90% sensitivity, 88% specificity and area under the curve=0.93 for identification of acute occlusions.

Conclusions Patients with NSTEMI due to acute coronary occlusions develop larger infarcts and more impaired left ventricular function than patients with NSTEMI without occlusions, regardless of infarct-related territory. Territorial circumferential strain by echocardiography enables very early identification of acute coronary occlusions in patients with NSTE-ACS and may be used for detection of patients requiring urgent revascularisation.

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Footnotes

  • Funding The study was supported by the South-Eastern Norway Regional Health Authority, the Norwegian Foundation for Health and Rehabilitation and Sørlandet Hospital HF. The supporters of the study had no role in the study design, collection, analyses or interpretation of data, or writing of the manuscript.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Southern Norway Regional Committee for Medical Research and Ethics.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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