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 1. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction. Results of the TIMI IIIB Trial. Thrombolysis in Myocardial Ischemia. Circulation. 1994;89(4):1545-56. doi: https://doi. org/10.1161/01.CIR.89.4.1545. 2. Braunwald E. Unstable angina: a classification. Circulation. 1989;80(2):410- 4. https://doi.org/10.1161/01.CIR.80.2.410. 3. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. 2012 ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(23):e179‑347. doi: 10.1016/j.jacc.2013.01.014. Erratum in: J Am Coll Cardiol. 2013;62(11):1040-1. 4. Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography; validation against sonomicrometry and taggedmagnetic resonance imaging. J AmColl Cardiol. 2006;47(4):789-93. doi: https://doi. org/10.1016/j.jacc.2005.10.040. 5. Choi JO, Cho SW, Song YB, Cho SJ, Song BG, Lee SC, et al. Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality. Eur J Echocardiogr. 2009;10(5):695-701. doi: 10.1093/ejechocard/jep041. 6. Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain imaging byechocardiography–fromtechnicalconsiderationstoclinicalapplications. J AmSoc Echocardiogr. 2007;20(3):234-43. doi: http://dx.doi.org/10.1016/j. echo.2006.08.023. 7. Geyer H, Caracciolo G, Abe H, Wilansky S, Carerj S, Gentile F, et al. Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr. 2010; 23(4):351-69. doi: 10.1016/j.echo.2010.02.015. Erratum in: J Am Soc Echocardiogr. 2010;23(7):734. 8. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, CannonCP, et al; Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163 (19): 2345-53. doi: 10.1001/archinte.163.19.2345. 9. Eagle KA, LimMJ, Dabbous OH, Pieper KS, Goldberg RJ, Van deWerf F, et al; GraceInvestigators.Avalidatedpredictionmodelforallformsofacutecoronary syndrome:estimatingtheriskof6-monthpostdischargedeathinaninternational registry. JAMA. 2004;291(22):2727-33. doi: 10.1001/jama.291.22.2727. 10. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al; Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification References segmental strain, we found a significant association only in basal segment deformity reduction of lateral and inferior walls, with stenosis ≥ 70% in CX and RD coronaries, respectively. We believe that segmental strain findings would be more robust if the sample was larger. In a meta-analysis published in 2016 with 1385 patients included in 10 studies, global longitudinal strain demonstrated good accuracy in detecting moderate to severe CAD in symptomatic patients with AUC of 0.81, sensitivity of 74.4% and specificity of 72.1%. 19 Despite the low SL2D applicability in ER and CU, most probably due to patients profile that our institution attends, current evidence and our findings indicate that this method may be a complementary exam in diagnostic algorithm of CAD and useful tool in early ischemia evaluation. Conclusion In 80.8% of the cases, it was not possible to apply longitudinal strain, mainly due to the following criteria: presence of previous infarction or prior revascularization (percutaneous or surgical). We believe that the method applicability in a profile of patients with less clinical complexity would be greater, due to the method technical limitations. In spite of this limitation, we can observe that the global strain showed a correlation with the presence of anatomically severe coronary lesion. In this way, SL2D could be included in the diagnostic arsenal of UA, in emergency units, since it is a noninvasive examination with diagnostic information available in a short period. Author contributions Conception and design of the research: Santos NSS, Vilela AA, Barretto RBM, Rezende MO, Ferreira MC, Andrade AJA, Scorsioni NHG, Queiroga OX, Le Bihan D; Acquisition of data: Santos NSS, Vilela AA, Vale MP, Rezende MO, Ferreira MC, Andrade AJA, Scorsioni NHG, Queiroga OX; Analysis and interpretation of the data: Santos NSS, Vilela AA, Barretto RBM, ValeMP, RezendeMO, FerreiraMC, Andrade AJA, Scorsioni NHG, Queiroga OX, Le Bihan D; Statistical analysis and Critical revision of the manuscript for intellectual content: Santos NSS, Vilela AA, RezendeMO, FerreiraMC, Andrade AJA, Scorsioni NHG, Queiroga OX; Obtaining financing andWriting of the manuscript: Vilela AA. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 360