Clinical InvestigationSignificance of Native and Allograft CADEarly Assessment of Strain Echocardiography Can Accurately Exclude Significant Coronary Artery Stenosis in Suspected Non–ST-Segment Elevation Acute Coronary Syndrome
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Study Population
Sixty-four patients with suspected NSTE-ACS without known coronary artery disease, inconclusive ECG findings, and normal cardiac biomarkers at admission were enrolled at Sørlandet Hospital Arendal. Patients admitted with suspected NSTE-ACS were enrolled if the following criteria were met: (1) acute anginal pain lasting >10 min, (2) episode of chest pain within the past 3 days, and (3) indication for coronary angiography according to current guidelines.9 Exclusion criteria were: (1) age < 18
Clinical and Angiographic Data
Of the 64 patients who had normal initial cTnT and inconclusive ECG findings, 35 (55%) did not have significant coronary artery stenosis and 29 (45%) had significant coronary artery stenosis by coronary angiography. Baseline and clinical data for patients with and without significant coronary artery stenosis are presented in Table 1. Time from onset of symptoms to arrival in the ER, time from arrival in the ER to echocardiographic examination, and time from arrival in the ER to coronary
Discussion
To our knowledge, this study is the first to evaluate myocardial strain by speckle-tracking as an early method to identify patients without significant coronary artery stenosis in a population with suspected NSTE-ACS with inconclusive ECG findings and normal initial cardiac biomarkers.
Earlier echocardiographic studies focused on how to detect patients with coronary disease.14 In contrast, this study was designed to describe how an accurate assessment of myocardial strain might exclude
Conclusions
The present study demonstrates that myocardial strain by speckle-tracking may be superior to conventional echocardiographic parameters in excluding significant coronary artery stenosis in patients with suspected NSTE-ACS, inconclusive ECG findings, and normal cardiac biomarkers. A combined strategy with electrocardiography, a single set of cardiac proteins, and measurement of myocardial strain by speckle-tracking echocardiography may aid clinicians in excluding significant coronary artery
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2021, Ultrasound in Medicine and BiologyCitation Excerpt :However, conventional echocardiographic assessment of global and regional left ventricular function based on visual analysis is subjective and observer dependent. In this situation, we require robust diagnostic tools to improve the identification of patients with significant coronary artery stenosis, who may benefit from further invasive examination and revascularization (Dahlslett et al. 2014). Speckle tracking echocardiography imaging has emerged as a validated tool for detecting ischemic wall motion abnormalities in resting echocardiography, providing quantitative analysis of myocardial deformation in the longitudinal, radial and circumferential directions (Geyer et al. 2010; Kusunose et al. 2011).
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This study was funded by the Norwegian Health Association, South-Eastern Norway Regional Health Authority, and Sørlandet Hospital (Arendal, Norway).