Li Yi-Tong, Shen Wen-Qian, Duan Xin, Li Yang, Wang Yan-Xia, Ren Xing-Xing, Liu Qi-Qi, Tian Jia-Wei, Du Guo-Qing
Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Heliyon. 2022 Oct 27;8(11):e11276. doi: 10.1016/j.heliyon.2022.e11276. eCollection 2022 Nov.
To explore the association between left atrial (LA) strain and the GRACE score in patients with acute coronary syndrome (ACS) and to investigate the utility of LA function in predicting short-term adverse cardiovascular events post ACS.
This retrospective study included ACS patients who underwent coronary angiography (CAG) in two independent cohorts from October 2020 to July 2022. The patients were classified into low-intermediate risk group and high-risk group based on the GRACE score. All participants underwent a transthoracic echocardiogram, with LA strain analysis before CAG. Correlation analysis was used to determine the relationship between LA strain and the GRACE score. The predictive value of LA strain was examined utilizing the area under the curve (AUC). Participants were followed for 10.5 ± 2.9 months for the primary endpoint of major adverse cardiovascular events (MACE).
A total of 229 patients were included in this study, including 196 in the primary group and 33 in the validation group. Spearman's correlation analysis showed there was a moderate negative correlation between the GRACE and left atrial reservoir strain (LASr) in both the primary (r = -0.63, < 0.001) and validation (r = -0.73, < 0.001) cohorts. Receiver operator characteristic (ROC) curve analysis showed that the AUC of LASr for prediction of the high-risk group was 0.86. Taking LASr 19.6% as the cut-off value, the sensitivity and specificity were 0.71 and 0.92, respectively. The cut-off value of 19.6% remains good at identifying high-risk group in the validation group (AUC = 0.87, sensitivity: 77.8%, specificity: 95.8%). Furthermore, 49 patients reached the endpoint in the primary cohort during the follow-up. On multivariable regression analysis, LASr ( = 0.03) was the independent echocardiographic predictor for the primary endpoint, rather than left atrial volume index (LAVI).
LASr can identify high-risk patients with ACS as defined by the GRACE score and may be superior to Max LAVI in predicting incidents of MACE in the short-term following ACS.
探讨急性冠状动脉综合征（ACS）患者左心房（LA）应变与GRACE评分之间的关联，并研究LA功能在预测ACS后短期不良心血管事件中的作用。
这项回顾性研究纳入了2020年10月至2022年7月期间在两个独立队列中接受冠状动脉造影（CAG）的ACS患者。根据GRACE评分将患者分为低中风险组和高风险组。所有参与者均接受经胸超声心动图检查，并在CAG前进行LA应变分析。采用相关性分析确定LA应变与GRACE评分之间的关系。利用曲线下面积（AUC）检验LA应变的预测价值。对参与者进行了10.5±2.9个月的随访，以主要不良心血管事件（MACE）作为主要终点。
本研究共纳入229例患者，其中主要组196例，验证组33例。Spearman相关性分析显示，在主要队列（r = -0.63，<0.001）和验证队列（r = -0.73，<0.001）中，GRACE与左心房储备应变（LASr）之间均存在中度负相关。受试者操作特征（ROC）曲线分析显示，LASr预测高风险组的AUC为0.86。以LASr 19.6%为截断值，敏感性和特异性分别为0.71和0.92。在验证组中，19.6%的截断值在识别高风险组方面仍表现良好（AUC = 0.87，敏感性：77.8%，特异性：95.8%）。此外，在主要队列的随访期间，有49例患者达到终点。多变量回归分析显示，LASr（=0.03）是主要终点的独立超声心动图预测指标，而非左心房容积指数（LAVI）。
LASr可识别由GRACE评分定义的ACS高危患者，在预测ACS后短期内MACE事件方面可能优于最大LAVI。
