Accuracy of Myocardial Speckle Tracking in Identifying the Culprit Vessel in Non‐ST‐Segment Elevation Acute Coronary Syndromes

PURPOSE: This study analyzed the diagnostic efficacy of electrocardiogram (ECG), transthoracic echocardiography (TTE), and speckle tracking echocardiography (STE) in identifying the culprit vessel (CV) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). It explored the feasibility and accuracy of the noninvasive STE technique in providing clinicians with CV-related information for treatment decision-making. METHODS: One hundred and forty-two NSTE-ACS patients were retrospectively analyzed to evaluate the diagnostic efficacy of ECG, wall motion score index (WMSI) of TTE, and territorial longitudinal strain (TLS) of STE in identifying the CV before coronary angiography (CAG). RESULTS: STE demonstrated superior accuracy (87.3%, p < 0.05) for CVs identification versus ECG (23.2%) and TTE (47.9%). The sensitivities of ECG, TTE, and STE in identifying the left anterior descending artery as the CV were 35.7%, 58.9%, and 89.3%, respectively (p < 0.05), with specificities of 88.4%, 90.7%, and 95.3%. For the right coronary artery, sensitivities were 17.5%, 35.0%, and 75.0% (p < 0.05; specificities: 93.1%, 92.1%, and 98.0%). For the left circumflex artery, sensitivities were 13.0%, 52.2%, and 95.7% (p < 0.05; specificities: 96.9%, 88.5%, and 87.5%). The WMSI + TLS model outperformed WMSI alone (p < 0.001). In multivessel disease, epicardial TLS (Epi - TLS) independently predicted the CV (p < 0.001) and surpassed other myocardial layers in diagnostic performance. CONCLUSION: This study demonstrated that STE showed superior accuracy to other noninvasive techniques in the identification of CV in NSTE-ACS patients before CAG. Epi-TLS offered unique value in discriminating the true CV among multivessel disease. STE offered practical bedside evaluation for NSTE-ACS patients before invasive procedures. TRIAL REGISTRATION: Dalian Friendship Municipal Hospital, China: CTR2500108952.