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Global longitudinal strain and long-term outcome in patients presenting to the emergency department with suspected acute coronary syndrome
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  • Alexander Fuks,
  • Noah Liel-Cohen,
  • David Blondheim,
  • Sara Shimoni,
  • Mohamed Jabaren,
  • Marina Leitman,
  • Salim Adawi,
  • Ronen Jaffe,
  • Basheer Karkabi,
  • Ihab Asmer,
  • Majdi Ganaeem,
  • Sergio Kobal,
  • Idit Lavi,
  • Walid Saliba,
  • Avinoam Shiran
Alexander Fuks

Corresponding Author:[email protected]

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Noah Liel-Cohen
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David Blondheim
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Sara Shimoni
Kaplan medical center
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Mohamed Jabaren
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Marina Leitman
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Salim Adawi
Carmel Hospital
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Ronen Jaffe
Carmel Hospital
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Basheer Karkabi
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Ihab Asmer
Carmel Hospital
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Majdi Ganaeem
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Sergio Kobal
Soroka Hospital
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Walid Saliba
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Avinoam Shiran
Carmel Hospital
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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.
13 Feb 2021Submitted to Echocardiography
15 Feb 2021Submission Checks Completed
15 Feb 2021Assigned to Editor
07 Mar 2021Reviewer(s) Assigned
02 May 2021Review(s) Completed, Editorial Evaluation Pending
03 May 2021Editorial Decision: Revise Minor
10 May 20211st Revision Received
10 May 2021Submission Checks Completed
10 May 2021Assigned to Editor
18 May 2021Reviewer(s) Assigned
20 May 2021Review(s) Completed, Editorial Evaluation Pending
20 May 2021Editorial Decision: Accept