MAPSE and duration of early systolic lenghtening are correlated with the presence of significant coronary artery disease in patients presenting with suspected NSTE-ACS

Coronary artery disease (CAD) remains a diagnostic challenge due to its broad clinical spectrum. Among acute coronary syndromes (ACS), non–ST-elevation presentations (NSTE-ACS) are heterogeneous, as significant coronary obstruction may not be present. Optimizing patient selection for coronary angiography is therefore crucial to reduce healthcare costs and complications. The 2023 ESC Guidelines recommend transthoracic echocardiography in cases of diagnostic uncertainty to identify regional wall motion abnormalities or alternative causes of chest pain. However, its diagnostic value in contemporary NSTE-ACS remains insufficiently defined.

We aimed to assess whether echocardiographic longitudinal parameters — global longitudinal strain (GLS), duration of early systolic lengthening (DESL), early systolic index (ESI), post-systolic index (PSI, Figure 1), and mitral annular plane systolic excursion (MAPSE) — could predict the presence of CAD in NSTE-ACS patients. These indices might detect early ischemic dysfunction before ejection fraction or wall motion abnormalities appear.

We prospectively enrolled 58 patients admitted with suspected NSTE-ACS. All underwent comprehensive echocardiography within 48h of symptom onset and subsequent coronary angiography. Significant CAD was defined as ≥1 major coronary aertery occlusion or ≥70% stenosis. Univariate and multivariable logistic regression were performed using backward selection, and ROC curves evaluated predictive accuracy.

Patients with CAD had significantly longer DESL (22 [15–31] vs 13 [5–20]ms; p = 0.008) and lower MAPSE (1.45 [1.19–1.70] vs 1.54 [1.41–2.10]cm; p = 0.044). No differences were observed in others echocardiographic baseline parameters. Logistic regression showed that MAPSE and DESL were significantly associated with CAD, with odds ratios (OR) of 0.22 (95% CI: 0.05-0.81, p = 0.03) and 1.05 (95% CI: 1.01-1.09, p = 0.04), respectively. The final multivariable regression model (age, sex, CK-MB, ΔhsTnT, ESI, MAPSE) achieved an AUC of 0.82 (95% CI: 0.71-0.93), with an optimal cut-off value of 0.59 resulting in a sensitivity of 73% and a specificity of 84%. DESL was the second-best predictor with an AUC of 0.70 (95% CI: 0.56-0.83) and an optimal cut-off value of 0.56 (19.04 msec), yielding a sensitivity of 70% and a specificity of 72%. MAPSE had an AUC of 0.66 (95% CI: 0.51-0.80), with an optimal cut-off value of 0.41 (1.96 cm), yielding a sensitivity of 94% and a specificity of 36%. Delta troponins showed moderate predictive ability, with AUCs of 0.62 (95% CI: 0.47-0.77).

In NSTE-ACS patients with normal LVEF and wall motion, DESL and MAPSE were significantly associated with CAD, with MAPSE emerging as the most robust and practical predictor. As a simple measurement, easily obtainable even in poor acoustic windows, MAPSE could serve as a rapid bedside tool to support early identification of CAD in emergency and intensive care settings.

Echocardiographic measurements