Mghaieth Zghal Fathia, Boudiche Selim, Houes Hedi, Fathallah Ines, Ouaghlani Khalil, Bonkano Ali, Ayari Jihen, Rekik Bassem, Ben Halima Manel, Ouali Sana, Mourali Mohamed Sami
Tunis Med. 2020 Jan;98(1):70-79.
Strain has shown a promising diagnostic and prognostic value in acute coronary syndromes. With, however, less data in non-ST elevation myocardial infarction (NSEMI).
to evaluate in NSTEMI patients, the ability of strain to predict the severity of the disease, by assessing correlations to established prognostic parameters, and to predict culprit and occluded coronary arteries (CA). Secondary, to determine factors associated to strain changes during follow-up.
The study was prospective, NSTEMI patients with significant coronary lesion and without significant non-ischaemic disease were included. Angiographic and echocardiographic investigation including global (GLS) and territorial (TLS) longitudinal strain were performed within 24h from admission. Syntax I score was calculated. Severe coronary artery disease (CAD) was defined by left main of three-vessel disease.
Seventy NSTEMI patients aged 60.2±10.1 years were enrolled; 61% were smokers, 54% diabetics and 46% hypertensive. 34% had a severe CAD, 7% had an acute coronary occlusion (ACO) and 14% a chronic coronary total occlusion (CTO). GLS >-15.3% predicted a left ventricular ejection fraction (LVEF) <50% with 80% Sensitivity (Se) and 78% Specificity (Sp). GLS was associated to CAD complexity and severity. GLS > -14.1% detected severe CAD with 83% Se and 80%Sp. TLS determined the culprit artery in 74% of cases and TLS > -9.2% predicted ACO with 85% Se and 85% Sp. TLS was also associated to CTO. At a 10 months median follow-up [3-12months], GLS significantly improved, baseline LVEF, GLS, wall motion score index and revascularization were the predictors of this improvement.
In NSTEMI patients, GLS detected severe CAD and poor myocardial function. TLS predicted the culprit vessel and its occlusion. GLS improvement at midterm was predicted by baseline systolic LV function parameters and myocardial revascularization.
应变在急性冠状动脉综合征中已显示出有前景的诊断和预后价值。然而，关于非ST段抬高型心肌梗死（NSEMI）的数据较少。
在非ST段抬高型心肌梗死（NSTEMI）患者中，通过评估与既定预后参数的相关性，评估应变预测疾病严重程度的能力，并预测罪犯血管和闭塞冠状动脉（CA）。其次，确定随访期间与应变变化相关的因素。
该研究为前瞻性研究，纳入有显著冠状动脉病变且无显著非缺血性疾病的NSTEMI患者。在入院后24小时内进行包括整体（GLS）和局部（TLS）纵向应变的血管造影和超声心动图检查。计算Syntax I评分。严重冠状动脉疾病（CAD）定义为左主干或三支血管病变。
纳入70例年龄为60.2±10.1岁的NSTEMI患者；61%为吸烟者，54%为糖尿病患者，46%为高血压患者。34%患有严重CAD，7%发生急性冠状动脉闭塞（ACO），14%发生慢性冠状动脉完全闭塞（CTO）。GLS > -15.3%预测左心室射血分数（LVEF）<50%，敏感性（Se）为80%，特异性（Sp）为78%。GLS与CAD的复杂性和严重程度相关。GLS > -14.1%检测严重CAD的Se为83%，Sp为80%。TLS在74%的病例中确定了罪犯血管，TLS > -9.2%预测ACO的Se为
