0051: Longitudinal 2D strain can efficiently diagnose CAD and localize the culprit lesion in patients with suspected non-ST-elevation acute coronary syndrome and presumed normal systolic function

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the clinical work-up of patients presenting with chest pain is a diagnostic challenge. Conventional echocardiography is not informative in half of the cases. We investigated the diagnostic performance of global (GLS) and territorial (TLS) longitudinal strain to predict CAD in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTEACS) but presumed normal global and regional systolic function. 58 patients with suspected NSTE-ACS but normal LVEF (≥55%) and WMSI (=1) were prospectively enrolled. Echocardiography (with speckle-tracking analyses) was performed on admission and all the patients underwent angiocoronarography. CAD was defined as the presence of stenosis of >50%. CAD was present in 33 patients (57%). LVEF was 60.7±4.6% in group 1 (CAD) and 61.1±5.0% in group 2 (no CAD). Global longitudinal strain (GLS) was altered in group 1 (–16.7±3.4%) as compared to group 2 (–22.4±2.9%, p<0.001). ROC curve analysis showed a high diagnostic value of GLS for the prediction of CAD (AUC=0.92 [0.84 – 1.00], p=0.0001) with a sensitivity of 81% and a specificity of 88% at the optimal cut-off of –19.7%, Diagnostic values of Troponin Ic (AUC=0.66) and ECG (AUC=0.63) were significantly lower. Territorial longitudinal strain (TLS) was able to discriminate between coronary stenosis in the LAD, LCX or RCA. longitudinal 2D strain has a good diagnostic value in patients presenting with NSTE-ACS but pnormal global and regional systolic function.