Abstract 11853: Coronary Artery Occlusions in Patients with Non-ST Elevation Acute Coronary Syndrome May Be Identified by Layer-Specific Strain Echocardiography

Abstract

Background: The left ventricular (LV) wall of the heart comprises 3 myocardial layers. The endocardial layer is most susceptible to ischemic injury. We hypothesised that patients with coronary occlusion have reduced endocardial function assessed by strain compared to patients without occlusion.

Methods and Results: We prospectively included 77 patients with suspected non-ST elevation (NSTE) acute coronary syndrome (ACS). Coronary angiography showed coronary occlusion in 28, significant stenosis in 21 and no stenosis in 28 patients. Echocardiography was performed before angiography. Layer-specific longitudinal and circumferential strains were assessed by 2D speckle-tracking echocardiography (2D-STE) from endo-, mid- and epicardium. Global longitudinal strain (GLS) was averaged from 16 and global circumferential strain (GCS) from 6 LV segments in all 3 layers. Patients with occlusion had worse function in all 3 myocardial layers assessed by GLS and GCS compared to patients without occlusion. Endocardial GLS and GCS were most affected, -14.8 ± 2.3% vs [[Unable to Display Character: &#8209;]]17.9 ± 2.6%, and -18.5 ± 3.7% vs -22.5 ± 4.3% , p<0.001 respectively. The absolute difference between global longitudinal endo- and epicardial and circumferential endo- and epicardial strains were lower in patients with occlusion than in those without occlusion (Table). This reflects a relatively more pronounced decrease of endocardial function in patients with occlusion. Receiver operating characteristic curve analyses showed that endo- and mid-myocardial GLS were significantly better to identify occlusion than epicardial GLS (p=0.01 and p=0.01, respectively), and EF (p<0.001 and p=0.003, respectively).

Conclusions: NSTE-ACS patients with coronary occlusion might be identified by assessing layer-specific strain using 2D-STE. Endocardial function was more affected than epicardial function in patients with coronary occlusion.