Reduced regional strain rate is the most accurate dysfunction in predicting culprit lesions in patients with acute coronary syndrome

BACKGROUND AND AIM: Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS. METHODS: In 80 consecutive patients with ACS (age 55.7 +/- 9.4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention. RESULTS: Of the 80 patients, one-vessel stenosis (>70%) was present in 53 (66%), two-vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending - LAD (r = 0.35, P = 0.005), circumflex LCx (r = 0.32, P = 0.03) and right coronary RCA (r = 0.37, P = 0.01). Only ECG changes in the LAD territory (r = 0.26, P = 0.04) correlated with the culprit lesion. SR of LAD territories