ABC | Volume 110, Nº4, April 2018

Original Article Santos et al Applicability of LV S2DL in unstable UA Arq Bras Cardiol. 2018; 110(4):354-361 Table 1 – Clinical characteristics of studied population (n = 78) Median [p25– 75] Age (years) 61,5 [53 – 69] Gender (%) Male 60,3% Female 39,4% BMI (Kg/m 2 ) 28,16 [24,47 – 30,71] SBP (mmHg) 137 [122,75 – 154,25] HR (bpm) 74 [69 – 83,5] Serum Creatinine (mg/dL) 0,9 [0,7 – 1,1] GRACE (points) 95 [81 – 117] Troponin (pg/mL) 0,02 [0,01 – 0,05] High blood pressure (%) 88,5% Diabetes (%) 38,5% Smoking (%) 32,1% Dyslipidemia (%) 65,4% Family history for CAD (%) 19,2% Known CAD (%) 66,7% Medications in use (%) ACEI 32,1% ARB 41% Beta blocker 65,4% Acetylsalicylic acid 82,1% Other antiplatelet 29,5% Calcium channel blocker 33,3% Statin 76,9% Nitrate 37,2% Prior Intervention (%) Surgical revascularization 11,5% Angioplasty 22,1% Angioplasty + Surgical revascularization 16,7% Previous MI (%) 56,4% BMI: body mass index; SBP: systolic blood pressure; HR: heart rate; CAD: coronary artery disease; AMI: acute myocardial infarction; ACEI: angiotensinogen converting enzyme inhibitor; ARB: angiotensin receptor AT-2 blocker. Coronary anatomy evaluation revealed a severe lesion in LMCA in 1 case (6.7%). Number of patients with severe lesions in coronary arteries AD, CX and RD was 2 (13.3%), 4 (26.7%) and 4 (26.7%), respectively. SL2D evaluation revealed a reduced global strain value in those who had severe lesion in any epicardial coronary artery (17.1 [3.1] versus 20.2 [6.7] with p = 0.014), area under the ROC curve 0.875, as shown in Figures 2 and 3. Segmental strain assessment showed an association between severe CX lesion and longitudinal strain reduction of lateral wall basal segment (14 [5] versus 21 [10] with p = 0.04 and area under ROC curve = 0.864), and (12.5 [6] versus 19 [8] with p = 0.026 and area under ROC curve = 0.86). Discussion Acquisition of images by ST with longitudinal strain determination allows a more complete myocardial function assessment and can detect subtle alterations in segmental contractility in ischemic heart disease patients, with good inter and intraobserver reproducibility. 7,12 Thus, this method has been gaining more space in coronary artery disease evaluation, with a large number of studies produced in recent years. 15-17 Table 2 – Electrocardiographic findings (n = 78) Change Frequency (%) LBBCD 10,3% RBBB 3,8% LASDB 2,6% RBBB + LASDB 2,6% LBBB 3,8% Q wave pathological 3,8% Pacemaker pace 3,8% High response AF 1,3% CVR anterosseptal 5,1% Previous CVR 5,1% Lower CVR 9% Side CVR 7,7% Diffuse CVR 11,5% Infra/ST > 0,5 mm 1,3% LBBCD: left bundle branch conduction disorder; RBBB: right bundle branch block; LASDB: left anterior superior divisional block; CVR: change in ventricular repolarization; LBBB: left bundle branch block;AF: atrial fibrillation. Table 3 – Echocardiographic findings (n = 55) Variable Median [p25 – p75] LVEF Simpson 0,59 [0,5 – 0,65] LA (mm) 39 [36 – 42] LVFDD (mm) 51 [48 – 56] LVFSD (mm) 32 [30 – 37,75] Septum (mm) 10 [9 – 11] Posterior wall (mm) 9 [9 – 11] Mass index (g/m 2 ) 124,5 [110 – 153,5] PASP (mmHg) 32 [31 – 36] Aorta root (mm) 34 [31 – 36] LVEF: left ventricular ejection fraction; LA: measurement of the left atrium; LVFDD: left ventricle final diastolic diameter; LVFSD: left ventricular final systolic diameter; PASP: pulmonary artery systolic pressure. 357