An observational study on global longitudinal strain in acute coronary syndrome and its correlation with coronary angiogram
DOI:
https://doi.org/10.18203/2349-3933.ijam20243766Keywords:
ACS, Coronary angiogram, GLS, Left ventricular strain, CADAbstract
Background: Coronary angiography (CA) is crucial for diagnosing acute coronary syndrome (ACS) and assessing coronary artery disease (CAD), enabling healthcare providers to determine treatment options and assess the risk of cardiovascular events. Global longitudinal strain (GLS) is a sensitive marker of cardiac function. This study aimed to determine the correlation between GLS in ACS and CA findings.
Methods: This prospective observational study was conducted at the cardiology department of the Salem government medical college. The study involved transthoracic echocardiography (TTE) to assess LV volumes, ejection fraction (EF), and LVGLS and strain analysis using 2D echocardiography to measure regional longitudinal peak systolic strain in different LV segments. CA was performed to visualise the coronary vessels and detect significant CAD.
Results: The study population consisted predominantly of male patients (n=93, 62%), with notable smoking (n=48, 32%) and alcohol consumption (n=36, 24%). A significant majority of the patients (n=111, 74%) exhibited ECG abnormalities. Obstruction was present in 82% of the patients (n=123), with those showing impaired myocardial function compared to those without obstruction. GLS values below 13.95 were more common in patients with obstruction (n=8 out of 11), indicating reduced myocardial deformation. The GLS demonstrated excellent diagnostic performance for detecting significant coronary artery obstruction, with a high sensitivity of 88.89%, specificity of 90.63%, and overall accuracy of 90.24%.
Conclusions: Our study revealed a strong correlation between reduced GLS and CAD, highlighting its importance in CAD assessment and risk stratification in ACS. GLS demonstrated excellent diagnostic performance for detecting significant CAD, showing high sensitivity and specificity.
Metrics
References
Acute coronary syndrome. Mayo Clinic 2023. Available at: https://www.mayoclinic.org/diseases-conditions/acute-coronary-syndrome/symptoms-causes/syc-20352136. Accessed on 10 September 2024.
Acute coronary syndrome. Medscape.com 2021. Available at: https://emedicine.medscape.com/article/1910735-overview?form=fpf. Accessed on 10 September 2024.
Theofilis P, Oikonomou E, Chasikidis C, Tsioufis K, Tousoulis D. Pathophysiology of acute coronary syndromes-diagnostic and treatment considerations. Life (Basel). 2023;13(7):1543.
Khawaja T, Janus S, Al-Kindi SG. Role of coronary CT angiography in the evaluation of acute chest pain and suspected or confirmed acute coronary syndrome. US Cardiol Rev. 2022;16:e11.
Nikolaou K, Alkadhi H, Bamberg F, Leschka S, Wintersperger BJ. MRI and CT in the diagnosis of coronary artery disease: indications and applications. Insights Imaging. 2011;2(1):9-24.
Kumar A, Cannon CP. Acute coronary syndromes: Diagnosis and management, part I. Mayo Clin Proc 2009;84(10):917-38.
Pathophysiology of acute coronary syndrome and heart failure. Available at: https://www.heartonline.org.au/articles/pathophysiology/pathophysiology-of-acute-coronary-syndrome-and-heart-failure. Accessed on 15 September 2024.
Nyberg J, Jakobsen EO, Østvik A, Holte E, Stølen S, Lovstakken L, et al. Echocardiographic reference ranges of global longitudinal strain for all cardiac chambers using guideline-directed dedicated views. JACC Cardiovasc Imaging. 2023;16(12):1516-31.
Ravnkilde K, Skaarup KG, Grove GL, Modin D, Nielsen AB, Falsing MM, et al. Change in global longitudinal strain following acute coronary syndrome and subsequent risk of heart failure. Int J Cardiovasc Imaging. 2021;37:3193-202.
Ng ACT, Sitges M, Pham PN, Tran DT, Delgado V, Bertini M, et al. Incremental value of 2-dimensional speckle tracking strain imaging to wall motion analysis for detection of coronary artery disease in patients undergoing dobutamine stress echocardiography. Am Heart J. 2009;158:836-44.
Nucifora G, Schuijf JD, Delgado V, Bertini M, Scholte AJ, Ng AC, et al. Incremental value of subclinical left ventricular systolic dysfunction for the identification of patients with obstructive coronary artery disease. Am Heart J. 2010;159(1):148-57.
Shimoni S, Gendelman G, Ayzenberg O, Smirin N, Lysyansky P, Edri O, et al. Differential effects of coronary artery stenosis on myocardial function: The value of myocardial strain analysis for the detection of coronary artery disease. J Am Soc Echocardiogr. 2011;24:748-57.
Montgomery DE, Puthumana JJ, Fox JM, Ogunyankin KO. Global longitudinal strain aids the detection of non-obstructive coronary artery disease in the resting echocardiogram. Euro Heart J Cardiovasc Imag. 2012;13:579-87.
Gaibazzi N, Pigazzani F, Reverberi C, Porter TR. Rest global longitudinal 2D strain to detect coronary artery disease in patients undergoing stress echocardiography: a comparison with wall-motion and coronary flow reserve responses. Echo Res Pract. 2014;1(2):61-70.
Biswas K, Mukherjee A, Nandi S, Khanra D, Sharma RK, Maji S. Utility of global longitudinal strain to detect significant coronary artery disease, its extent and severity in patients with stable ischemic heart disease. Echocardiography. 2020;37:2000-9.
Bhuyan S, Satapathy C, Mohanty N. To determine how beneficial global longitudinal strain (GLS) at rest is for detecting substantial coronary artery disease. J Cardiovasc Dis Res. 2023;14:289-99.
Fuks A, Liel-Cohen N, Blondheim DS, Shimoni S, Jabaren M, Leitman M, et al. Global longitudinal strain, and long-term outcome in patients presenting to the emergency department with suspected acute coronary syndrome. Echocardiography. 2021;38(8):1254-62.