Clinical significance in the time course of rotation/twist in reducing left ventricular strain in patients with unstable angina and myocardial infarction with preserved ejection fraction of the left ventricle according to speckle tracking echocardiography

The research purpose was to study the performance of left ventricular (LV) rotation and twist under the decrease in LV longitudinal and circumferential strains and to determine the possible association of such changes with the risk of cardiovascular complications according to the GRACE 2.0 scale in patients with unstable angina and myocardial infarction with preserved ejection fraction of the left ventricle.

Materials and Methods. The study included 320 patients with acute coronary syndrome (unstable angina and myocardial infarction)  with preserved ejection fraction of the left ventricle ≥50%. The patients were divided into groups depending on the magnitude of longitudinal and circumferential strains: the first group - absence of longitudinal and circumferential dysfunction, 27 patients (8,5%); the second group – predominant longitudinal dysfunction (global longitudinal strain (GLS)) <16% with global circumferential strain (GCS) ≥25%, 68 patients (21,2%); the third group - transmural dysfunction (GLS <16% and GCS <25%), 225 patients (70,3%). Echocardiography was performed with the use of US scanner Affiniti 70. In 2D speckle-tracking mode the values of longitudinal (LS, %) and circumferential (CS, %) strains were assessed, the values of GLS and GCS, peaks of systolic basal and apical rotation, the values of LV twist and twist index were calculated. Additionally, the strain index was evaluated. All patients underwent coronary angiography with the calculation of the Gensini score; the risk of cardiovascular complications was calculated according to the Global Registry of Acute Coronary Events (GRACE) scale version 2.0.

Results. It was found out that patients in the 3rd group may have initial signs of heart failure due to more severe coronary myocardial damage. The medium value of GLS in patients of the third group was less than 12%, which is one of the criteria for reducing the contractility of the LV myocardium, a significant independent predictor of the occurrence of cardiovascular complications (CVC), and serves as a reason for therapy optimization in such patients. A distinctive feature of the patients in the second group, apart from the initial decrease in GLS, is a significant increase in the strain index, which can be used to evaluate the contribution of both individual indicators and their combination to LV contractility.

Conclusion. In patients with unstable angina and myocardial infarction with preserved ejection fraction, the initial decrease (13–16%) of the left ventricle longitudinal strain with preserved circumferential strain was characterized by increased values of LV rotation and twist. A relationship between a decrease in LV longitudinal strain of less than 12% and the risk of CVC was found. In values of longitudinal strain more than 12%, the increased risk of CVC may be further refined by the combined index based on rotation/twist (strain index), the diagnostic value of which requires further investigation.

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