Raslan Mahmoud, Elkhashab Khaled A, Mousa Mohamed G, Alghamdi Yazid A, Ghareb Haytham S
Cardiovascular Medicine, King Fahd Hospital of the University, Al Khobar, SAU.
Cardiology, Fayoum University Hospital, Fayoum, EGY.
Cureus. 2022 Apr 11;14(4):e24025. doi: 10.7759/cureus.24025. eCollection 2022 Apr.
Introduction A preliminary assessment of patients who suffer from severe and complex coronary artery lesions, such as three-vessel disease and/or a left main (LM) artery lesion, plays a critical contribution in determining prognosis and treatment plans for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Therefore, a pre-angiography (i.e., before angiography) predictor was required to cost-effectively evaluate severe and complex coronary lesions to efficiently direct our subsequent dealing. Aim This study aimed to compare two-dimensional (2D) and three-dimensional (3D) global longitudinal strain (GLS) at the regional level to assess extremely complicated coronary lesions using the SYNTAX score as a standard of reference in 100 patients with NSTE-ACS. Materials and methods This research included 100 patients with non-ST-segment elevation acute coronary syndrome who presented at the Cardiology Department at Fayoum University from December 2019 to July 2020. All patients underwent a complete history and physical examination, hemoglobin A1c (HbA1c), lipid profile, creatinine assessment, 12-lead electrocardiogram (ECG), and transthoracic echocardiography (TTE) to detect global and regional longitudinal strain by 2D and 3D speckle-tracking echocardiography (STE). Coronary angiography was done on all patients within 24 hours of admission after acquiring echo images. Then, the results of 2D and 3D regional and global longitudinal strain (GLS) to predict the severity and coronary lesion complexity in terms of the SYNTAX score were compared. Results This study revealed that 2D GLS was -12.10 ± 3.51, which is significantly higher than 3D GLS of -11.64 ± 4.05 (p < 0. 001). The left anterior descending coronary artery (LAD) and left circumflex artery (LCX) territories revealed a significantly higher value using 2D regional longitudinal strain (-11.13 ± 4.47 and -12.54 ± 4.11, respectively) than using 3D regional longitudinal strain (-10.84 ± 5.18 and -12.05 ± 4.29, respectively) (p= 0.017 and p < 0.001, respectively). There were significantly lower 2D GLS, 3D GLS, global circumferential strain (GCS), area strain, and global radial strain (GRS) in the intermediate and high score group than in the low score group of patients (p < 0.001 for all). Conclusion 2D and 3D strain echocardiography including GLS, GCS, GRS, and area strain are a noninvasive and rapid tool with clinical utility for evaluating coronary lesions in patients with NSTE-ACS. They can be routinely used to diagnose and stratify high-risk patients with NSTE-ACS, thereby potentially resulting in improved patient assessment. GLS as measured by 2D and 3D STE at minimal effort is a significant risk factor for patients with complex NSTE-ACS. In NSTE-ACS cases, the GLS absolute value is significantly associated with the degree of complexity of coronary artery lesions.
引言 对患有严重复杂冠状动脉病变（如三支血管病变和/或左主干病变）的患者进行初步评估，对于确定非ST段抬高型急性冠状动脉综合征（NSTE-ACS）的预后和治疗方案起着关键作用。因此，需要一种血管造影前（即血管造影前）预测指标，以经济高效地评估严重复杂冠状动脉病变，从而有效地指导我们后续的处理。
目的 本研究旨在比较100例NSTE-ACS患者二维（2D）和三维（3D）整体纵向应变（GLS）在区域水平上的差异，以SYNTAX评分作为参考标准来评估极其复杂的冠状动脉病变。
材料和方法 本研究纳入了2019年12月至2020年7月在法尤姆大学心脏病科就诊的100例非ST段抬高型急性冠状动脉综合征患者。所有患者均接受了完整的病史和体格检查、糖化血红蛋白（HbA1c）、血脂谱、肌酐评估、12导联心电图（ECG）以及经胸超声心动图（TTE）检查，通过二维和三维斑点追踪超声心动图（STE）检测整体和区域纵向应变。在获取超声心动图图像后的24小时内，对所有患者进行冠状动脉造影。然后，比较二维和三维区域及整体纵向应变（GLS）在预测SYNTAX评分方面冠状动脉病变严重程度和复杂性的结果。
结果 本研究显示，二维GLS为-12.10±3.51，显著高于三维GLS的-11.64±4.05（p<0.001）。使用二维区域纵向应变时，左前降支冠状动脉（LAD）和左旋支冠状动脉（LCX）区域的值（分别为-11.13±4.47和-12.54±4.11）显著高于使用三维区域纵向应变时的值（分别为-10.84±5.18和-12.05±4.29）（p分别为0.017和p<0.
