| Acute coronary occlusion in non-ST-elevation acute coronary syndrome: outcome and early identification by strain echocardiography. | |
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MedLine Citation:
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PMID: 20643662 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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OBJECTIVES: To compare infarct size and left ventricular ejection fraction in patients with non-ST-elevation myocardial infarction (NSTEMI) with and without acute coronary occlusions, and determine if myocardial strain by speckle-tracking echocardiography can identify acute occlusions in patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: 111 patients with suspected NSTE-ACS were enrolled shortly after admittance. Echocardiographic measurements were performed a median of 1 h (interquartile range 0.5-4) after admittance, and coronary angiography 36 ± 21 h after onset of symptoms. Territorial longitudinal and circumferential strain was calculated based on the perfusion territories of the three major coronary arteries in a 16-segment model of the left ventricle, and compared with traditional echocardiographic parameters. Long-term follow-up was by echocardiography and contrast-enhanced magnetic resonance imaging (ceMRI). RESULTS: Patients with NSTEMI due to acute coronary occlusion had higher peak troponin T than patients with NSTEMI without acute occlusions (4.9 ± 4.7 vs 0.9 ± 1.1 μg/l, p<0.001), larger infarct size by ceMRI (13 ± 8% vs 3 ± 3%, p<0.001) and poorer left ventricular ejection fraction (48 ± 6% vs 57 ± 6%, p<0.001) at follow-up. Territorial circumferential strain was the best parameter for predicting acute coronary occlusion. A territorial circumferential strain value >-10.0% had 90% sensitivity, 88% specificity and area under the curve=0.93 for identification of acute occlusions. CONCLUSIONS: Patients with NSTEMI due to acute coronary occlusions develop larger infarcts and more impaired left ventricular function than patients with NSTEMI without occlusions, regardless of infarct-related territory. Territorial circumferential strain by echocardiography enables very early identification of acute coronary occlusions in patients with NSTE-ACS and may be used for detection of patients requiring urgent revascularisation. |
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Authors:
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Bjørnar Grenne; Christian Eek; Benthe Sjøli; Thomas Dahlslett; Michael Uchto; Per K Hol; Helge Skulstad; Otto A Smiseth; Thor Edvardsen; Harald Brunvand |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-07-18 |
Journal Detail:
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Title: Heart (British Cardiac Society) Volume: 96 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9602087 Medline TA: Heart Country: England |
Other Details:
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Languages: eng Pagination: 1550-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Sørlandet Hospital, Arendal 4809, Norway. |
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Comment In:
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Heart. 2010 Oct;96(19):1516-7
[PMID:
20837668
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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