INTRODUCTION

This study was conducted to determine the utility of two-dimensional speckle tracking echocardiography (2D STE) in predicting major adverse cardiac events (MACEs) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).

METHODOLOGY

This is a prospective cohort study that included 91 patients diagnosed to have NSTE-ACS. In-hospital and 6-month MACEs were evaluated in relation to their baseline echocardiographic parameters, 2D speckle strain, and strain rate analyses.

RESULTS

Among the conventional echocardiographic parameters, only left ventricular end-systolic diameter (LVESD) and wall motion scores showed significant difference between those with and without outcomes after 6 months. Significant higher wall motion scores (24.06 vs 20.91 P = 0.0320) and LVESD (3.36 vs 2.97 cm, P = 0.0125) were noted among those who had MACE after 6 months. There were no significant differences among the 2D STE strain and strain rate between those patients with and without MACE during their hospital admission. However, after 6-month follow-up, significantly lower mean left ventricular global longitudinal strain (GLS) (−14.22% ± 4.45% vs −16.44% ± 4.19%, P = 0.0261) and strain rate (−0.69 ± 0.36 s-1 vs −0.94 ± 0.25 s-1, P = 0.009) were observed among patients with MACE compared with those without. Incidence of reduced GLS strain and strain rate was significantly higher in those with MACE after 6 months. Left ventricular GLS sensitivity and specificity were 64.64% and 61.70%, respectively, at a cutoff value of less than −15.0% for detecting MACE within 6 months. Left ventricular GLS cutoff point less than −12.0%, which detects severe LV dysfunction in previous studies, have a sensitivity of 40% but a high specificity of 82.98% for predicting MACE after 6 months.

CONCLUSION

Both LV GLS strain and strain rate can be used to predict major adverse cardiovascular events after NSTE-ACS.

cardiac events ; Cardiovascular Diseases

INTRODUCTION: Maldistribution of echocardiographic expertise is a relevant issue in an archipelago such as the Philippines. We specifically looked at (1) the nationwide census of physician echocardiographers, cardiac sonographers, and cardiac laboratory managers; (2) their geographic distribution; and (3) background training and laboratory classification. METHODS: Data from paper and online surveys conducted in 2015 and 2021 were consolidated alongside the existing society database. Surveys (Google Forms; Google, Mountain View, California) were disseminated through a variety of online, social media, and communication avenues and focused on three categories of respondents: (1) physician echocardiographers, (2) cardiac sonographers, and (3) laboratory managers. The main variables of interest included estimated census per category and geographical distribution. Secondary variables included training background and laboratory classification. RESULTS: In 2021, there were 651 physician echocardiographers, 2487 cardiac sonographers, and 443 cardiac laboratory managers on record, with86 readers, 405 sonographers, and 101 managers responding to the survey. The majority of the surveyed readers (41.2%), sonographers (48.3%), and laboratory managers (28.2%) were situated in the National Capital Region. Close to half of the readers were level III echocardiographers. The majority of the sonographers (46.7%) were nurses, followed by medical technologists (21.8%) and radiologic technologists (18.9%).Most laboratory managers were in nontraining hospitals (38.2%) or stand-alone facilities (20.9%). The minority were in hospitals with cardiology (18.2%) or internal medicine (22.7%) training programs. CONCLUSION Geographical maldistribution of echocardiographic resources is still evident, with the majority of human resources being concentrated in the metropolis. The majority of the sonographers have nursing as their training background, and many laboratory managers are situated in facilities with no established training programs.
echocardiography ; laboratories ; resources ; health resources ; surveys and questionnaires