Ionac Ioana, Lazăr Mihai-Andrei, Șoșdean Raluca, Văcărescu Cristina, Simonescu Marius, Luca Constantin-Tudor, Mornoș Cristian
Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Cardiology Department, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania.
Diagnostics (Basel). 2023 Feb 16;13(4):745. doi: 10.3390/diagnostics13040745.
Global longitudinal strain (GLS) and mechanical dispersion (MD), as determined by 2D speckle tracking echocardiography, have been demonstrated to be reliable indicators of prognosis in a variety of cardiovascular illnesses. There are not many papers that discuss the prognostic significance of GLS and MD in a population with non-ST-segment elevated acute coronary syndrome (NSTE-ACS). Our study objective was to examine the predictive utility of the novel GLS/MD two-dimensional strain index in NSTE-ACS patients. Before discharge and four to six weeks later, echocardiography was performed on 310 consecutive hospitalized patients with NSTE-ACS and effective percutaneous coronary intervention (PCI). Cardiac mortality, malignant ventricular arrhythmia, or readmission owing to heart failure or reinfarction were the major end points. A total of 109 patients (35.16%) experienced cardiac incidents during the follow-up period (34.7 ± 8 months). The GLS/MD index at discharge was determined to be the greatest independent predictor of composite result by receiver operating characteristic analysis. The ideal cut-off value was -0.229. GLS/MD was determined to be the top independent predictor of cardiac events by multivariate Cox regression analysis. Patients with an initial GLS/MD > -0.229 that deteriorated after four to six weeks had the worst prognosis for a composite outcome, readmission, and cardiac death according to a Kaplan-Meier analysis (all < 0.001). In conclusion, the GLS/MD ratio is a strong indicator of clinical fate in NSTE-ACS patients, especially if it is accompanied by deterioration.
二维斑点追踪超声心动图测定的整体纵向应变（GLS）和心肌离散度（MD）已被证明是多种心血管疾病预后的可靠指标。关于GLS和MD在非ST段抬高型急性冠状动脉综合征（NSTE-ACS）人群中的预后意义的论文并不多。我们的研究目的是检验新型GLS/MD二维应变指数在NSTE-ACS患者中的预测效用。在出院前以及出院四至六周后，对310例连续住院的NSTE-ACS患者及接受有效经皮冠状动脉介入治疗（PCI）的患者进行了超声心动图检查。主要终点为心脏死亡、恶性室性心律失常或因心力衰竭或再梗死而再次入院。共有109例患者（35.16%）在随访期（34.7±8个月）内发生心脏事件。通过受试者工作特征分析确定出院时的GLS/MD指数是复合结果的最强独立预测因子。理想的临界值为-0.229。多变量Cox回归分析确定GLS/MD是心脏事件的首要独立预测因子。根据Kaplan-Meier分析，初始GLS/MD＞-0.229且在四至六周后恶化的患者在复合结局、再次入院和心脏死亡方面预后最差（所有P＜0.001）。总之，GLS/MD比值是NSTE-ACS患者临床转归的有力指标，尤其是当其伴有恶化时。
