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Category: Volume 07 Issue 08 August 2019
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Title: Gender Based Prognostication Value of Left Ventricular Global Longitudinal Strain with Grace Score in non St Elevation Myocardial Infarction – A Single Centre Experience

Authors: Suresh Madhavan, Jayaprasad N, V Sudhakumary, Gargi Sathish, Jayaprakash K, K.J. Raihanathul Misiriya, V.L. Jayaprakash, Raju George

 DOI: https://dx.doi.org/10.18535/jmscr/v7i8.85

Abstract

Aims: Coronary risk stratification using GRACE score [Global Registry of Acute Coronary Events] and early treatment is beneficial in NSTEMI [Non ST elevation Myocardial Infarction]. We aimed to evaluate utility of peak systolic Global Longitudinal Strain [GLS] score along with GRACE score in identifying patients at high risk for cardiac events & to observe any gender related impact of these scores in predicting MACE [Major Adverse Cardiac Events] following an episode of NSTEMI.

Methods: We prospectively studied 636 patients admitted to Medical College, Kottayam, India with diagnosis of NSTEMI during the period of 3 years from 2014 to 2017. All patients were categorised in to low, moderate and high GRACE score groups along with GLS score measurement. 6 months MACE was statistically analysed.

Results: Females with NSTEMI had less negative GLS scores compared to male counterparts. The optimal cut off value of GLS for prediction of significant Coronary artery disease [CAD] in at least one coronary arterial territory in the study population was found as ≥-15.7 (AUC 0.797, p value 0.009). The sensitivity, specificity and positive predictive value [PPV] of GLS for detecting significant CAD were 89%, 70%, and 83.3% respectively. 6 months MACE was high in females compared to males with similar levels of GRACE score. MACE in different GRACE groups were higher when the GLS score was ≥-15.7.

Conclusion: In patients with NSTEMI, simple bedside echocardiographic assessment of peak systolic GLS score calculation, when used with the GRACE score can increase the prognostic value, especially in females. For comparable GRACE scores ,the risk of cardiac events were higher in females compared to males when the GLS score is ≥-15.7.

Keywords: NSTEMI, GRACE score, Global longitudinal strain.

References

  1. Ramjane Khalill MD, Lei Han MD, Chang Jing PhD, He Quan PhD The use of risk scores for stratification of non-ST elevation acute coronary syndrome patients Exp Clin Cardiol Vol 14 No 2 2009]
  2. Gong IY, Goodman SG, Brieger D, Gale CP, Chew DP, Welsh RC, Huynh T, De Young JP, Baer C, Gyenes GT, Udell JA, Fox KAA, Yan AT; Canadian GRACE/ GRACE-2 and CANRACE Investigators: GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome. Int J Cardiol. 2017 Oct 1; 244:24-29.
  3. GRACE Score Validation in Predicting Hospital Mortality: Analysis of the Role of sex: De-Miguel-Balsa Eva, Latour-Pérez Jaime, Baeza-Román Anna, Amorós-Verdú Cristina, Fernández-Lozano Juan Antonio, and the ARIAM-SEMICYUC group. Journal of Women's Health. May 2017, 26(5): 420-425.
  4. Munk K, Andersen NH, Nielsen SS, et al. GLS by speckle tracking for infarct size estimation. Eur J Echocardiogr 2011; 12:156–65.
  5. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7:79–108.
  6. Nesbitt GC, Mankad S, Oh JK. Strain imaging in echocardiography: methods and clinical applications. Int J Cardiovasc Imaging 2009; 25(Suppl 1):9–22
  7. Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. CircCardiovasc Imaging 2009; 2:356–64.
  8. Ersboll M, Valeur N, Mogensen UM, et al. Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction. J Am Coll Cardiol 2013; 61:2365–73.
  9. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography Patrick Collier, MD, PHD, Dermot Phelan, MD, PHD, Allan Klein, MD vol69,no:8,2017 J Am Coll Cardiolhttp://dx.doi.org/10.1016/j.jacc.2016.12.012
  10. Eek C, Grenne B, Brunvand H, Aakhus S, Endresen K, Hol PK, Smith HJ, Smiseth OA, Edvardsen T, Skulstad H. Strain echocardiography and wall motion score index predicts final infarct size in patients with non-ST-segment-elevation myocardial infarction. Circ Cardiovasc Imaging 2010; 3:187-94
  11. Grenne B, Eek C, Sjoli B, Skulstad H, Aakhus S, Smiseth OA, Edvardsen T, Brunvand H. Changes of myocardial function in patients with non-ST-elevation acute coronary syndrome awaiting coronary angiography. Am J Cardiol 2010; 105:1212-8.
  12. Picano E, Lattanzi F, Orlandini A, Marini C, L’Abbate A. Stress echocardiography and human factor: the importance of being expert. J Am Coll Cardiol 1991; 17:666-9.
  13. Urheim S, Edvardsen T, Torp H, Angelsen B, Smiseth OA. Myocardial strain by Doppler echocardiography: validation of new method to quantify regional myocardial function. Circulation 2000; 102:1158-64.
  14. Edvardsen T, Helle-Valle T, Smiseth OA. Systolic dysfunction in heart failure with normal ejection fraction: speckle-tracking echocardiography. Prog Cardiovasc Dis 2006; 49:207-14.
  15. Edvardsen T, Helle-Valle T, Smiseth OA. Systolic dysfunction in heart failure with normal ejection fraction: speckle-tracking echocardiography. Prog Cardiovasc Dis 2006; 49:207-14.
  16. Thibault H, Derumeaux G. Assessment of myocardial ischemia and viability using tissue Doppler and deformation imaging: the lessons from the experimental studies. Arch Cardiovac Dis 2008; 101:61-78.
  17. Wang J, Khoury DS, Yue Y, Torre-Amione G, and Nagueh SF. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Eur Heart J 2008; 29:1283-9.
  18. Chan J, Hanekom L, Wong C, Leano R, Cho GY, Marwick TH. Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function. J Am CollCardiol 2006; 48:2026-33.
  19. Prevalence of coronary artery disease andits risk factors in Kerala, South India: a community-based cross-sectional study :M. N. Krishnan, G. Zachariah, K. Venugopal, P. P. Mohanan, S. Harikrishnan, G. Sanjay, L. Jeyaseelan, K. R. Thankappan .BMC Cardiovascular Disorders (2016) 16:12
  20. N. Krishnan, Coronary heart disease and risk factors in India,on the brink of an epidemic? Indian Heart Journal 64 [2012]364e367
  21. Teerapat Yingchoncharoen, MD Shikhar Agarwal, MD, MPH Zoran B. Popović, MD, PhD,Thomas H. MarwickNormal Ranges of Left Ventricular Strain: A Meta-Analysis, Journal of American Society of Echocardiography, February 2013, Volume 26, Issue 2, Pages 185–191
  22. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study: Salim Yusuf, Steven Hawken, Stephanie Ôunpuu, Tony Dans, Alvaro Avezum, Fernando Lanas, Matthew McQueen, Andrzej Budaj , Prem Pais, John Varigos, LiuLisheng , INTERHEART Study Investigators, The Lancet, volume 364,no.9438,p937-952,11 september 2004.

Corresponding Author

Dr Suresh Madhavan

Associate professor, Government Medical College, Kottayam, Kerala, India 686008