Role of Segmental and Global Left Ventricular Strain in Diagnosis of Acute Coronary Syndrome

Aim To determine the role of left ventricular segmental (SLS) and general longitudinal strain (GLS) in early diagnosis of acute coronary syndrome (ACS).
Material and methods The study included 112 patients aged 58±7 years with suspected ACS without a history of ischemic heart disease (IHD) who were admitted to the hospital within 12 h of complaint onset. The control group consisted of 20 healthy, age- and sex-matched subjects. Speckle-tracking echocardiography was performed to assess SLS and GLS on admission and discharge. Ischemia was diagnosed when the SLS was decreased to 14% or lower with a simultaneous post-systolic shortening (PSS) of these segments >20% or when the initial lengthening of the segments was followed by PSS.
Results Decreased SLS with PSS of one or more segments was observed in 51.8 % of patients; 16.1% of patients had initial systolic lengthening of one or more segments followed by PSS. In 30.3 % of patients, GLS was 15.5 % or less; 82.3% of these patients had SLS disorders. Later, ACS was diagnosed in 72.3 % of the patients. ACS was not confirmed in 4 (5.2%) of 76 (67.9 %) patients with abnormal SLS changes. All these patients had low SLS values and high PSS values and did not have the initial systolic segmental lengthening. Seven of 9 (8 %) patients with false-negative SLS values had distal narrowing of a coronary artery and two patients had narrowing in the middle part of the artery. All patients with ACS and decreased GSL had a hemodynamically significant narrowing of more than one coronary artery. Incidence of two and more stenosed arteries was higher in patients with PSS and low GSL. Sensitivity and specificity of SLS for diagnosis of acute ischemia were 88.9 and 84.6 %, respectively.
Conclusion Assessment of LV strain has high sensitivity and specificity for diagnosis of ACS in patients with the first IHD episode. The presence of PSS associated with decreased GSL may indicate multivascular IHD.

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