Interest of the study of left ventricular function by 2D Strain in acute coronary syndrome

Abstract

Background :  The 2D Strain is a new echo-cardiographic technique allowing the study of the myocardial deformation based on a follow-up of the acoustic markers of the LV wall. The aim of our study was to validate the contribution of this technique in the detection of the ischemia and in the prediction of the culprit coronary axis and the number of vessels affected and also we analyzed the correlation of this parameter with the Left Ventricle Ejection Fraction (LVEF) and the Wall Motion Score Index (WMSI).                                                                                                   
Methods : This is a prospective study included 173 consecutive patients admitted for acute coronary syndrome (ACS) during the period between January 2015 and October 2016.  All the patients had echocardiography with analysis of function by 2DStrain and a coronary angiography .The data have been listed on an SPSS database.                                                                                                         Results :  The mean LVEF was 50 +/- 10%, the mean global longitudinal peak systolic strain (GLPSS) was -14 +/- 4% and the mean WMSI was 1.68 +/- 0.4.  The study showed that GLPSS was more impaired when Left Anterior Descending (LAD) is affected with an average of -13.9% versus -17.2% and -17.8% for Left Circumflex (LCx) and Right Coronary Artery (RCA) respectively and was more impaired also when the patients have two or three-vessel lesions with an average of -13.7% versus -15.8% in the single-vessel lesions. The statistical study showed a significant correlation between GLPSS and the age (p = 0.007); the type of ACS (p =0.017); the LVEF (p <0.001)and the WMSI(p <0.001).The study showed a significant correlation between GLPSS and the severity of coronary artery disease (p <0.001) and especially a significant correlation with the culprit coronary axis (p <0.001).In Fact ; the longitudinal strain has been predicted the culprit coronary axis in 92% of the cases in our study.                                                                                     
 Conclusion : The 2D Longitudinal Strain represents an excellent parameter which allows a reliable detection of an alteration in the systolic function of the LV in ischemic heart disease and it’s very useful to predict the culprit coronary axis and the number of vessels affected.