Acute Coronary Syndrome, Myocardial Infarction, Non-ST Elevation Myocardial Infarction (NSTEMI)
Conditions
Keywords
Left atrial strain, Reservoir strain, Speckle tracking echocardiography, GRACE score, Major adverse cardiovascular events, NSTEMI, Prognostic value
Brief summary
This prospective observational study aims to evaluate whether left atrial reservoir strain, measured by two-dimensional speckle tracking echocardiography, independently predicts 6-month major adverse cardiovascular events (MACE) and provides incremental prognostic value beyond the GRACE 2.0 score, left ventricular ejection fraction, and left atrial volume index in patients with non-ST-elevation myocardial infarction.
Detailed description
Non-ST-elevation myocardial infarction (NSTEMI) carries significant short- and long-term risk of major adverse cardiovascular events despite advances in management. Current risk stratification relies on clinical scores such as GRACE 2.0 and conventional echocardiographic parameters including left ventricular ejection fraction (LVEF) and left atrial volume index (LAVI). These tools have limitations, as LVEF may remain preserved and LAVI mainly reflects chronic remodeling. Left atrial (LA) reservoir strain assessed by two-dimensional speckle tracking echocardiography is a sensitive marker of left ventricular filling pressure and diastolic function. Reduced LA reservoir strain has been associated with adverse outcomes after NSTEMI, but data on its incremental prognostic value beyond established risk models remain limited. This prospective observational study will assess whether LA reservoir strain independently predicts 6-month MACE and improves risk discrimination when added to the GRACE 2.0 score and conventional echocardiographic parameters in patients with NSTEMI.
Interventions
None listed
Sponsors
Assiut University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years * Confirmed diagnosis of NSTEMI according to current ESC/ACC guidelines * Willingness to provide informed consent and complete 6-month follow-up * Undergoing coronary angiography or revascularization during the index hospitalization
Exclusion criteria
* ST-elevation myocardial infarction (STEMI) * Atrial fibrillation or other significant arrhythmia at presentation * Moderate to severe valvular heart disease (especially mitral valve disease) * Prior cardiac surgery or valve replacement * Poor echocardiographic image quality precluding reliable strain analysis * Chronic kidney disease on dialysis * Known cardiomyopathy (hypertrophic, dilated, or infiltrative) * Pregnancy * Refusal to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 6-month major adverse cardiovascular events (MACE) | 6 months | Composite of cardiac death, recurrent myocardial infarction, heart failure hospitalization, or life-threatening arrhythmia occurring within 6 months of admission. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Left atrial reservoir strain | Baseline | Peak atrial longitudinal strain (PALS) during the reservoir phase measured by two-dimensional speckle tracking echocardiography (EchoPAC software), expressed as percentage (%). Higher values indicate better left atrial function. |
| Change in risk discrimination with addition of LA reservoir strain | 6 months | Change in risk discrimination for 6-month MACE when left atrial reservoir strain is added to the GRACE 2.0 score, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI), assessed by change in C-statistic, Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI). |
| Optimal cutoff value of LA reservoir strain | 6 months | Optimal cutoff value of left atrial reservoir strain for predicting 6-month MACE determined by receiver operating characteristic (ROC) curve analysis. |
| Correlation of LA reservoir strain with clinical parameters | Baseline | Correlation between left atrial reservoir strain (expressed as percentage) and the following parameters: GRACE 2.0 score, peak troponin level (ng/L), left ventricular ejection fraction (%), and E/e' ratio. Correlation will be assessed using Pearson or Spearman correlation coefficient. |
Contacts
CONTACTAhmed A Abu Al-Abbass
STUDY_CHAIRHatem A Helmy, prof
Department of Cardiology, Faculty of Medicine, Assiut University
Outcome results
None listed