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The association between myocardial early systolic lengthening and high risk angiographic territory involvement in patients with non-ST-segment elevation myocardial infarction

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Abstract

Background

Non-ST-segment elevation myocardial infarction (NSTEMI) is more common than ST-segment elevation myocardial infarction (STEMI), consisting of 60–70% of myocardial infarctions. When left ventricular (LV) pressure increases during early systole, regionally ischaemic myocardium with a reduced active force exhibit stretching. The aim of this study was to evaluate the role of this parameter in determining high risk angiographic territory involvement in NSTEMI patients.

Results

This study was a descriptive correlational research that was conducted on 96 patients with NSTEMI and a left ventricular ejection fraction ≥ 50% who underwent coronary angiography (CAG). Patients were divided into two groups based on having or not having high risk angiographic territory involvement in CAG. All patients underwent a transthoracic echocardiography during the first day of hospitalization and early systolic lengthening (ESL), duration of ESL (DESL), left ventricular global longitudinal strain (LVGLS), pulsed-wave Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e′) and peak systolic (s′) velocities were determined. The results of this study showed DESL, DESLLAD, and DESLLCX were longer in high risk angiographic territory group than other one (P value 0.016, 0.044, and 0.04, respectively). The logistic regression analysis showed among different variables, only age and ESLLAD had an independent association with high risk angiographic territory involvement (P = 0.01, odds ratio [OR] 1.09, 95% CI 1.021–1.164, and P = 0.024, odds ratio [OR] 1.243, 95% CI 1.029–1.50, respectively).

Conclusions

Assessment of myocardial ESLLAD by speckle-tracking echocardiography may be helpful in predicting high risk angiographic territory involvement in patients with NSTEMI. Indeed, a higher value can be considered as a high risk parameter which may show benefit of an early invasive strategy versus a conservative approach.

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Availability of data and materials

The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.

Abbreviations

AMI:

Acute myocardial infarction

NSTEMI:

Non-ST-segment elevation myocardial infarction

STEMI:

ST-segment elevation myocardial infarction

LV:

Left ventricle

CAG:

Coronary angiography

ESL:

Early systolic lengthening

DESL:

Duration of early systolic lengthening

E wave:

Pulsed-wave Doppler-derived transmitral early diastolic velocity

A wave:

Pulsed-wave Doppler-derived transmitral late diastolic velocity

e′:

Tissue-Doppler-derived mitral annular early diastolic velocity

s′:

Tissue-Doppler-derived mitral annular peak systolic velocity

LAD:

Left anterior descending artery

LCX:

Left circumflex artery

RCA:

Right coronary artery

2D:

Two-dimensional

CAD:

Coronary artery disease

LVEF:

Left ventricular ejection fraction

TnI:

Troponin I

HTN:

Hypertension

DM:

Diabetes mellitus

HLP:

Hyperlipidemia

Chol:

Cholesterol

BMI:

Body mass index

LVGLS:

Left ventricular peak global longitudinal strain

LA:

Left atrium

DT:

Deceleration time

IVS:

Interventricular septum

LVIDd:

End-diastolic LV internal dimension

PWT:

Posterior wall thickness

SWT:

Septal wall thickness

ACS:

Acute coronary syndrome

PCI:

Percutaneous coronary intervention

MI:

Myocardial infarction

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Acknowledgements

This study was Dr. Saeed Kavousi postgraduate thesis. The authors would like to thank all participants and hospital staff for their support in this research.

Funding

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Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran

    Maryam Nabati

  2. Student Research Committee, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran

    Saeed Kavousi

  3. Department of Biostatics, Faculty of Health, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran

    Jamshid Yazdani

  4. Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

    Homa Parsaee

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  1. Maryam Nabati
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Contributions

MN designed the study, collected data and approved final version of manuscript, JY performed statistical analysis, SK reviewed literature and clinical data and interpreted results, and HP collected data and wrote the draft.

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Correspondence to Maryam Nabati.

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This study was approved by Mazandaran University of Medical science ethical committee (ethics code no. IR.MAZUMS..REC.1400.9258).

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Nabati, M., Kavousi, S., Yazdani, J. et al. The association between myocardial early systolic lengthening and high risk angiographic territory involvement in patients with non-ST-segment elevation myocardial infarction. J Ultrasound (2024). https://doi.org/10.1007/s40477-024-00885-w

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