Wasim Zahid1, Christian Hesbø Eek2, Espen W Remme3, Helge Skulstad2, Erik Fosse4, Thor Edvardsen5. 1. Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway The Intervention Center, Oslo University Hospital, Oslo, Norway University of Oslo, Oslo, Norway. 2. Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway. 3. The Intervention Center, Oslo University Hospital, Oslo, Norway KG Jebsen Cardiac, Research Center, Oslo, Norway. 4. The Intervention Center, Oslo University Hospital, Oslo, Norway University of Oslo, Oslo, Norway. 5. Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway University of Oslo, Oslo, Norway thor.edvardsen@medisin.uio.no.
Abstract
AIMS: Ischaemic myocardial segments tend to stretch as the intraventricular pressure rises steeply during the isovolemic contraction phase, before they contract during ejection. We hypothesized that the time they remain stretched, called duration of early systolic lengthening (DESL), correlates with final infarct size as defined by contrast enhanced magnetic resonance imaging (CE-MRI). We also assessed whether DESL could identify patients with acute coronary occlusion, and compared it with traditional measures for myocardial function. METHODS AND RESULTS: In this retrospective study, 150 consecutive patients with Non-ST-elevation acute coronary syndrome (NSTE-ACS) referred for coronary angiography were included. Speckle tracking echocardiography was performed prior to angiography to determine DESL. The final infarct size was quantified at follow-up 9 ± 3 months after initial admission in 61 patients and echocardiography performed in 143 patients. DESL showed good correlation with the final infarct size (r = 0.67, P < 0.001). Thirteen patients had no visible sign of infarct on CE-MRI (minimal myocardial damage), and DESL was significantly shorter in these patients than in patients with signs of infarct (27 ± 19 vs. 84 ± 41 ms, P < 0.001). Compared with left ventricular ejection fraction, wall motion score index, and global longitudinal strain, DESL showed the best accuracy in detecting patients with minimal myocardial damage, with an area under the receiver operating characteristic curve of 0.92 (0.82 to 0.99, P < 0.001). DESL was more prolonged in patients with coronary occlusions, compared with those without occlusions (86 ± 45 vs. 63 ± 31 ms, P < 0.01). DESL was significantly shorter at follow-up, compared with baseline (P = 0.04). CONCLUSIONS: DESL could identify patients with minimal myocardial damage, differentiate between occlusion and non-occlusion, and may be helpful in the risk stratification of patients with NSTE-ACS. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Ischaemic myocardial segments tend to stretch as the intraventricular pressure rises steeply during the isovolemic contraction phase, before they contract during ejection. We hypothesized that the time they remain stretched, called duration of early systolic lengthening (DESL), correlates with final infarct size as defined by contrast enhanced magnetic resonance imaging (CE-MRI). We also assessed whether DESL could identify patients with acute coronary occlusion, and compared it with traditional measures for myocardial function. METHODS AND RESULTS: In this retrospective study, 150 consecutive patients with Non-ST-elevation acute coronary syndrome (NSTE-ACS) referred for coronary angiography were included. Speckle tracking echocardiography was performed prior to angiography to determine DESL. The final infarct size was quantified at follow-up 9 ± 3 months after initial admission in 61 patients and echocardiography performed in 143 patients. DESL showed good correlation with the final infarct size (r = 0.67, P < 0.001). Thirteen patients had no visible sign of infarct on CE-MRI (minimal myocardial damage), and DESL was significantly shorter in these patients than in patients with signs of infarct (27 ± 19 vs. 84 ± 41 ms, P < 0.001). Compared with left ventricular ejection fraction, wall motion score index, and global longitudinal strain, DESL showed the best accuracy in detecting patients with minimal myocardial damage, with an area under the receiver operating characteristic curve of 0.92 (0.82 to 0.99, P < 0.001). DESL was more prolonged in patients with coronary occlusions, compared with those without occlusions (86 ± 45 vs. 63 ± 31 ms, P < 0.01). DESL was significantly shorter at follow-up, compared with baseline (P = 0.04). CONCLUSIONS: DESL could identify patients with minimal myocardial damage, differentiate between occlusion and non-occlusion, and may be helpful in the risk stratification of patients with NSTE-ACS. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Philip Brainin; Sune Haahr-Pedersen; Flemming Javier Olsen; Anna Engell Holm; Thomas Fritz-Hansen; Thomas Jespersen; Gunnar Gislason; Tor Biering-Sørensen Journal: J Am Heart Assoc Date: 2020-01-24 Impact factor: 5.501
Authors: Philip Brainin; Søren Lindberg; Flemming J Olsen; Sune Pedersen; Allan Iversen; Søren Galatius; Thomas Fritz-Hansen; Gunnar Gislason; Peter Søgaard; Rasmus Møgelvang; Tor Biering-Sørensen Journal: Int J Cardiol Heart Vasc Date: 2021-05-28