Background: In our previous research (1) we have shown 2D analysis of regional longitudinal peak systolic strain (LPSS) to be superior to visual assessment of regional wall motion abnormalities (RWMA) in detection of ischemia-induced loss of myocardial contractility due to non-ST elevation acute coronary syndrome (NSTE-ACS). (2, 3) The reduction of LPSS in basal segments in patients with arterial hypertension (AH) is well documented. The aim of this study was to assess the impact AH has on the accuracy of regional analysis in predicting the localization of significant stenosis in NSTE-ACS.

Methods: We performed a retrospective analysis of patients admitted to University Hospital Centre Zagreb from January 2013 till December 2015 due to NSTE-ACS. Exclusion criteria were no coronary angiography, absence of ECHO, and prior coronary artery disease. Total of 123 patients (62±12 years, 68% male) were included. 4 blinded clinicians performed regional LPSS analysis using 18-segment model, while RWMA, interpreted by clinician performing the echo, were categorized according to the wall motion score guidelines.

Results: Significant correlation between flow limiting stenosis (>70% narrowing on angiography), worse RWMA and a decrease of regional LPSS in basal segments was found for all 3 coronary vessels (Table 1). Patients with AH (73%) showed a lower regional LPSS and worse RWMA in all basal segments, with only lateral and posterior ones varying significantly (Figure 1). However, regression analysis accounting for AH as a covariant, showed the regional changes in basal segments to be a sole result of coronary disease (Table 2). AH was found to have no impact on reliability of LPSS and RWMA in predicting the localization of significant stenosis in NSTE-ACS (average method sensitivities: 59% vs 38%).

Conclusion: Changes in regional myocardial contractility, detected by either LPSS or RWMA, in patients with NSTE-ACS should be attributed to coronary disease irrespectively of the presence of AH.