Rohit Manoj Kumar, Sihag Bhupendra Kumar, Revaiah Pruthvi C, Karki Pragya, Batta Akash, Patel Nitin Kumar J, Sambyal Bharat Singh, Gawalkar Atit A
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Echocardiogr. 2025 Jun 26. doi: 10.1007/s12574-025-00696-w.
Non-ST-elevation myocardial infarction (NSTEMI) is conventionally attributed to subtotal or transient occlusion. ECG is crucial but has limited sensitivity for detecting acute total occlusion in patients with NSTEMI. We propose that speckle tracking echocardiography-derived indices serve as early indicators of coronary artery occlusion in NSTEMI.
In this case-control study, 47 patients with first-time hemodynamically stable NSTEMI were enrolled and underwent echocardiography and coronary angiography. Patients were divided into acute occlusion and non-occlusion groups for analysis. Reproducibility analysis was done in a separate cohort of 22 patients with each patient undergoing three sets of strain echocardiography analysis: twice by the principal observer on two different instances (for intra-observer reproducibility) and once by second observer on the first instance (for inter-observer reproducibility).
The study included 24 cases (patients with acute total occlusion) and 23 controls (patients without acute total occlusion). There was no difference between the two groups in relation to baseline characteristics. Left-ventricular global longitudinal strain (GLS) did not differ significantly between the two groups. Median longitudinal strain (LS) of the culprit artery territory was significantly lower in the cases group [8.1(7.1-12.6) vs 11.6(10.9-14.1), and p = 0.003]. The lowest recorded mean territorial (LRMT) LS of any territory in a given patient was significantly lower in the cases group compared to the control group [8.1(6.7-12.1) vs. 11(10.2-13), p = 0.04). The receiver-operator curve of LRMT LS showed an area under the curve of 0.74. A cut-off value 10.7 for LRMT LS had a sensitivity of 70.8% and specificity of 70% in detecting acute total occlusion. Reproducibility analysis of GLS and territorial strain (each territory separately) showed moderate-to-good [interclass correlation coefficient (ICC)) of ≥ 0.5] inter-observer and intra-observer reproducibility in most of parameters except in territorial strain of left circumflex artery territory which showed poor intra-observer reproducibility (ICC of 0.49).
The lowest recorded mean territorial LS in patients with NSTEMI showed promising sensitivity and specificity in detecting acute total occlusion.
非ST段抬高型心肌梗死（NSTEMI）传统上归因于次全闭塞或短暂闭塞。心电图至关重要，但在检测NSTEMI患者急性完全闭塞方面敏感性有限。我们提出，斑点追踪超声心动图衍生指标可作为NSTEMI患者冠状动脉闭塞的早期指标。
在这项病例对照研究中，纳入了47例首次血流动力学稳定的NSTEMI患者，这些患者接受了超声心动图和冠状动脉造影检查。将患者分为急性闭塞组和非闭塞组进行分析。在一个单独的由22例患者组成的队列中进行了重复性分析，每位患者接受三组应变超声心动图分析：主要观察者在两个不同时间进行两次分析（用于观察者内重复性），第二位观察者在第一次时间进行一次分析（用于观察者间重复性）。
该研究包括24例（急性完全闭塞患者）和23例对照（无急性完全闭塞患者）。两组在基线特征方面无差异。两组之间左心室整体纵向应变（GLS）无显著差异。病例组罪犯动脉区域的中位数纵向应变（LS）显著更低[8.1（7.1 - 12.6）对11.6（10.9 - 14.1），p = 0.003]。与对照组相比，病例组中给定患者任何区域记录的最低平均区域纵向应变（LRMT）LS显著更低[8.1（6.7 - 12.1）对11（10.2 - 13），p = 0.04]。LRMT LS的受试者工作特征曲线显示曲线下面积为0.74。LRMT LS的截断值为10.7时，检测急性完全闭塞的敏感性为70.8%，特异性为70%。GLS和区域应变（每个区域分别）的重复性分析显示，除左旋支动脉区域的区域应变观察者内重复性较差（组内相关系数（ICC）为0.49）外，大多数参数的观察者间和观察者内重复性为中度至良好（ICC≥0.5）。
NSTEMI患者记录到的最低平均区域LS在检测急性完全闭塞方面显示出有前景的敏感性和特异性。
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