Diagnosis of Non ST Segment Elevation Acute Coronary Syndrome Using Noninvasive Assessment of Left Ventricular Myocardial Work and Other Speckle Tracking Echocardiography Parameters

Objective: to evaluate the feasibility of identifying patients with significant coronary artery disease by assessing global and regional longitudinal strain (LS) parameters and left ventricular myocardial work (LVMW) among patients hospitalized with non-ST-segment elevation acute coronary syndrome (NSTE‑ACS), in the absence of visually apparent contractility abnormalities on standard echocardiography.

Material and Methods. The study included 82 patients hospitalized in the intensive care unit with a diagnosis of NSTE‑ACS between 2023 and 2024, without contractility abnormalities in standard echocardiography (EchoCG). The patients’ age ranged from 38 to 93 years. At admission, the risk of an adverse outcome was assessed using the GRACE score; standard and speckle‑tracking echocardiography were performed to determine global and regional longitudinal strain parameters and LVMW. Coronary angiography (CAG) was carried out within 48 hours.  Based on CAG findings, patients were divided into two groups: 30 patients with coronary artery (CA) stenosis ≤75 % and 52 patients with stenosis ≥75 %. The control group consisted of 30 volunteers without coronary heart disease.

Results. No differences observed between the compared groups with respect to GRACE risk score, electrocardiographic (ECG) abnormalities in the end-ventricular complex, or standard EchoCG parameters. However, differences were noted in all global longitudinal strain and LVMW parameters, as well as in regional longitudinal strain, myocardial work index, and myocardial work efficiency. The highest sensitivity and specificity for predicting significant CA disease were observed for a global work index ≤1783 mm Hg·% (73 % and 87 % (AUC = 0.88), respectively), and for a regional work index ≤1550 mm Hg·% in at least 5 adjacent segments ( 83 % and 87 % (AUC = 0.9), respectively).

A segmental increase in early systolic and postsystolic indices by ≥20 % demonstrated low sensitivity but high specificity for predicting significant CA disease (39 % and 97 %, and 48 % and 90 %, respectively), which adds value for verifying the localization of the longitudinal myocardial fibers damage.

Conclusion. Assessment of speckle‑tracking EchoCG parameters with evaluation of LVMW at the time of admission in patients hospitalized with NSTE‑ACS with no local contractility abnormalities enables prediction of CA disease and identification of priority candidates for invasive diagnostic evaluation.

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