Department of Cardiology, National Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan.
Department of Cardiovascular Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan.
J Echocardiogr. 2023 Dec;21(4):157-164. doi: 10.1007/s12574-023-00612-0. Epub 2023 Jul 12.
Although there is reportedly a usefulness of left ventricular global longitudinal strain (LV GLS) on 2D speckle-tracking echocardiography in excluding significant coronary artery disease (CAD) in suspected intermediate- or low-risk non-ST-segment elevation-acute coronary syndrome (NSTE-ACS), the efficacy of post-systolic index (PSI) in this context is yet unknown. Therefore, we explored the usefulness of PSI in facilitating stratification of risk in patients with intermediate- or low-risk NSTE-ACS.
We assessed 50 consecutive patients suspected of intermediate- or low-risk NSTE-ACS, and finally analyzed 43 patients whose echocardiographic images were suitable for strain analysis. All patients underwent CAG. Among the 43 analyzed patients, 26 had CAD, and 21 underwent percutaneous coronary intervention (PCI). Patients with CAD had higher PSI (25% [20.8-40.3%] vs 15% [8.0-27.5%], P = 0.007). Receiver-operator characteristic curve analysis identified that a PSI of > 20% detected performance of PCI (sensitivity 80.7%, specificity 70.6%, area under curve [AUC] 0.72, 95% confidence interval [CI] 0.57-0.88). Moreover, the AUC obtained using the GRACE risk score was 0.57 (95% CI 0.39-0.75), and increased to 0.75 (95% CI 0.60-0.90) when PSI and LV GLS were added. Thus, the addition of PSI and LV GLS improved the classification of performance of PCI (net reclassification improvement [95%CI] 0.09 [0.0024-0.18], P = 0.04).
Post-systolic index is a useful parameter that can facilitate stratification of risk in patients with intermediate- or low-risk NSTE-ACS. We recommend measuring PSI in routine clinical practice.
据报道，二维斑点追踪超声心动图测量左心室整体纵向应变（LV GLS）对于排除疑似中低危非 ST 段抬高型急性冠脉综合征（NSTE-ACS）患者的显著冠状动脉疾病（CAD）具有一定的作用，但是 PSI 在这种情况下的作用尚不清楚。因此，我们探讨了 PSI 在中低危 NSTE-ACS 患者分层危险中的作用。
我们评估了 50 例疑似中低危 NSTE-ACS 的连续患者，最终分析了 43 例超声心动图图像适合应变分析的患者。所有患者均接受 CAG。在 43 例分析患者中，26 例患有 CAD，21 例接受了经皮冠状动脉介入治疗（PCI）。CAD 患者的 PSI 更高（25%[20.8%-40.3%] vs 15%[8.0%-27.5%]，P=0.007）。受试者工作特征曲线分析发现，PSI>20%可以检测到 PCI 的性能（敏感性 80.7%，特异性 70.6%，曲线下面积[AUC]0.72，95%置信区间[CI]0.57-0.88）。此外，GRACE 风险评分的 AUC 为 0.57（95%CI 0.39-0.75），当加入 PSI 和 LV GLS 时，AUC 增加到 0.75（95%CI 0.60-0.90）。因此，PSI 和 LV GLS 的加入改善了 PCI 性能的分类（净重新分类改善[95%CI]0.09[0.0024-0.18]，P=0.04）。
PS 是一种有用的参数，可以帮助中低危 NSTE-ACS 患者分层危险。我们建议在常规临床实践中测量 PSI。
