Global longitudinal strain and long-term outcome in patients presenting
to the emergency department with suspected acute coronary syndrome
Abstract
Aims: We have previously shown that 2-dimentional strain is not a useful
tool for ruling out acute coronary syndrome (ACS) in the emergency
department (ED). The aim of the present study was to determine whether
in patients with suspected ACS, global longitudinal strain (GLS),
measured in the ED using 2-dimensional strain imaging, can predict
long-term outcome. Methods: Long-term (median 7.7 years [IQR
6.7-8.2]) major adverse cardiac events (MACE; cardiac death, ACS,
revascularization, hospitalization for heart failure or atrial
fibrillation) and all-cause mortality data was available in 525/605
patients (87%) enrolled in the Two-Dimensional Strain for Diagnosing
Chest Pain in the Emergency Room (2DSPER) study. The study prospectively
enrolled patients presenting to the ED with chest pain and suspected ACS
but without a diagnostic ECG or elevated troponin. GLS was computed
using echocardiograms performed within 24 hours of chest pain. MACE of
patients with worse GLS (> median GLS) was compared to
patients with better GLS ( median GLS). Results: Median GLS was
-18.7%. MACE occurred in 47/261 (18%) of patients with worse GLS as
compared with 45/264 (17%) with better GLS, adjusted HR 0.87 (95% CI
0.57-1.33, P=0.57). There was no significant difference in all-cause
mortality or individual end-points between groups. GLS did not predict
MACE even in patients with optimal 2-dimensional image quality (n=164,
adjusted HR=1.51, 95% CI 0.76-3.0). Conclusions: GLS did not predict
long-term outcome in patients presenting to the ED with chest pain and
suspected ACS, supporting our findings in the 2DSPER study.