Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Haar, M.
Early Identification of Acute Coronary Occlusion in Patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) by Wall Motion Analysis.
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2017. pp. 152
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Berghold Andrea
- Altmetrics:
- Abstract:
- Background. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS) frequently lack typical electrocardiographic signs when the coronary artery is occluded. Since acute coronary occlusions (ACO) are associated with worse outcome, further measures are needed to increase diagnostic sensitivity in this subgroup. The aim of this thesis is to evaluate the feasibility of regional wall motion analysis (RWMA) by two-dimensional echocardiography to detect ACO in patients with non-ST elevation myocardial infarction (NSTEMI). Methods. For this interim analysis twenty patients with NSTEMI and onset of chest pain within 24 hours at presentation to the emergency department were prospectively enrolled to undergo echocardiography before coronary angiography. Patients were recruited from July 2016 to July 2017 in four centres and underwent echocardiographic RWMA by either strain echocardiography (speckle tracking) or wall motion score index (WMSI) based the availability of strain echocardiography. Results. Out of twenty patients five (25 %) had an ACO on coronary angiography. RWMA by strain echocardiography and WMSI both showed a trend towards impaired regional left ventricular function in patients with ACO, although none of the obtained parameters were significant. Functional risk areas (FRA) by strain (8 vs. 3 segments) and WMSI (4 vs. 2 segments) were higher in patients with ACO when compared to those without. Furthermore, absolute territorial longitudinal peak systolic strains were lower in patients with ACO regardless of the culprit artery (LAD: 11.7 ± 2.3 % vs. 15.0 ± 4.4 %; LCX: 13.1 ± 1.4 % vs. 14.4 ± 4.9 %; RCA: 14.3 ± 3.1 % vs. 15.8 ± 3.8 %). Conclusion. Although this thesis cannot contribute to the hypothesis of detecting ACO by two-dimensional echocardiography (mostly due to the low sample size), the currently available literature strongly suggests an increase in sensitivity for detecting ACO by using echocardiography in addition to the already employed diagnostic approach.