Avinoam Shiran1,2, David S Blondheim2,3, Sara Shimoni4,5, Mohamed Jabarren6, David Rosenmann7, Alex Sagie8, David Leibowitz9, Marina Leitman10, Micha Feinberg11, Ronen Beeri9, Salim Adawi1,2, Avraham Shotan2,3, Sorel Goland4,5, Lev Bloch6, Sergio L Kobal12,13, Noah Liel-Cohen12,13. 1. Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel. 2. Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. 3. Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel. 4. Kaplan Medical Center, Rehovot, Israel. 5. Hebrew University, Jerusalem, Israel. 6. Department of Cardiology, Haemek Medical Center, Afula, Israel. 7. Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel. 8. Department of Cardiology, Rabin medical Center, Petah Tikva, Israel. 9. Hadassah-Hebrew University Medical Center, Jerusalem, Israel. 10. Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel. 11. Heart Center, Sheba Medical Center, Tel Hashomer, Israel. 12. Devision of Cardiology, Soroka University Medical Center, Beer Sheva, Israel. 13. Ben Gurion University of the Negev, Beer Sheva, Israel.
Abstract
AIMS: Left ventricular (LV) two-dimensional longitudinal strain (2DLS) analysis by echocardiography has been suggested as a useful tool for the detection of acute coronary syndromes (ACS). Our aim was to determine whether 2DLS analysis could assist in triage of patients with chest pain (CP) in the emergency department (ED). METHODS AND RESULTS: We prospectively enrolled patients presenting to the ED with CP and suspected ACS but without a diagnostic ECG or elevated troponin. An echocardiogram was performed within 24 h of CP. For each patient, a histogram of LV myocardial peak systolic strain (PSS) was generated and the value identifying the 20% worst strain values (PSS20%) was determined. A predefined value of greater than -17% was considered abnormal. 2DLS analysis was available for 605 patients (mean age 58 ± 9 years, 70% males), of which 74 (12.2%) had ACS. During a 6-month follow-up, MACE occurred in 4 (5.8%) patients with and in 3 (0.6%) without ACS. An abnormal PSS20% was present in 60/74 patients with ACS (sensitivity 81%, negative predictive value 91%), but also in 391/531 patients without ACS (specificity 26%, positive predictive value 13%). Similar results were found for global longitudinal strain (GLS). Receiver-operating characteristic curves showed an area under curve of 0.59 for PSS20% and 0.6 for GLS (P= 0.3). Independent predictors of abnormal 2DLS were male gender, body mass index, heart rate, and mean tissue Doppler e', but not ACS. CONCLUSION: In this large multicentre prospective study, 2DLS was not a useful tool to rule out ACS in the ED. CLINICAL TRIAL REGISTRATION: http://clinicaltrials.gov. UNIQUE IDENTIFIER: NCT01163019. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Left ventricular (LV) two-dimensional longitudinal strain (2DLS) analysis by echocardiography has been suggested as a useful tool for the detection of acute coronary syndromes (ACS). Our aim was to determine whether 2DLS analysis could assist in triage of patients with chest pain (CP) in the emergency department (ED). METHODS AND RESULTS: We prospectively enrolled patients presenting to the ED with CP and suspected ACS but without a diagnostic ECG or elevated troponin. An echocardiogram was performed within 24 h of CP. For each patient, a histogram of LV myocardial peak systolic strain (PSS) was generated and the value identifying the 20% worst strain values (PSS20%) was determined. A predefined value of greater than -17% was considered abnormal. 2DLS analysis was available for 605 patients (mean age 58 ± 9 years, 70% males), of which 74 (12.2%) had ACS. During a 6-month follow-up, MACE occurred in 4 (5.8%) patients with and in 3 (0.6%) without ACS. An abnormal PSS20% was present in 60/74 patients with ACS (sensitivity 81%, negative predictive value 91%), but also in 391/531 patients without ACS (specificity 26%, positive predictive value 13%). Similar results were found for global longitudinal strain (GLS). Receiver-operating characteristic curves showed an area under curve of 0.59 for PSS20% and 0.6 for GLS (P= 0.3). Independent predictors of abnormal 2DLS were male gender, body mass index, heart rate, and mean tissue Doppler e', but not ACS. CONCLUSION: In this large multicentre prospective study, 2DLS was not a useful tool to rule out ACS in the ED. CLINICAL TRIAL REGISTRATION: http://clinicaltrials.gov. UNIQUE IDENTIFIER: NCT01163019. Published on behalf of the European Society of Cardiology. All rights reserved.