Value of territorial work efficiency estimation in non-ST-segment-elevation acute coronary syndrome: a study with non-invasive left ventricular pressure-strain loops

Int J Cardiovasc Imaging. 2021 Apr;37(4):1255-1265. doi: 10.1007/s10554-020-02110-1. Epub 2020 Nov 23.

Abstract

Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with normal left ventricular (LV) ejection fraction (LVEF) and wall motion require a non-invasive tool to detect LV risk areas. This study utilized non-invasive LV pressure-strain loops to evaluate territorial myocardial work efficiency (WE) for identifying obstructive coronary artery stenosis, in patients with non-obstructive or obstructive coronary artery stenosis NSTE-ACS, the latter with or without occlusion. Global and territorial longitudinal strain (LS) analyses were performed via speckle-tracking imaging before coronary angiography. LV pressure-strain loops estimated global and territorial myocardial work index (MWI), constructive work (CW), wasted work (WW), and WE. Receiver operating characteristic curve analysis was used to determine the optimal cutoff value of independent parameters to detect obstructive coronary artery stenosis. Compared with non-obstructive, obstructive coronary artery stenosis showed significantly lower global and territorial LS, MWI, CW, and WE, and higher WW. Territorial LS, MWI, CW, and WE were significantly worse in territories of coronary occlusion. Territorial WE was the best parameter for predicting obstructive coronary artery stenosis (AUC 0.80, cutoff < 96%, sensitivity 73%, specificity 70%, P < 0.001). In patients with NSTE-ACS with normal wall motion and LVEF, territorial WE is more accurate than territorial LS or MWI to identify LV risk areas.

Keywords: Myocardial work efficiency; Obstructive coronary artery disease; Pressure–strain loops; Speckle-tracking imaging.

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging*
  • Acute Coronary Syndrome / physiopathology
  • Aged
  • Coronary Angiography
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / physiopathology
  • Echocardiography, Doppler*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Non-ST Elevated Myocardial Infarction / diagnostic imaging*
  • Non-ST Elevated Myocardial Infarction / physiopathology
  • Observer Variation
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Ventricular Function, Left*
  • Ventricular Pressure*