Background and Aim: Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS. Methods: In 80 consecutive patients with ACS (age 55·7 ± 9·4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention. Results: Of the 80 patients, one-vessel stenosis (>70%) was present in 53 (66%), two-vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending – LAD (r = 0·35, P = 0·005), circumflex LCx (r = 0·32, P = 0·03) and right coronary RCA (r = 0·37, P = 0·01). Only ECG changes in the LAD territory (r = 0·26, P = 0·04) correlated with the culprit lesion. SR of LAD territories ≤−0·74 was 71% sensitive and 70% specific (AUC = 0·70, CI = 0·67–0·93, P = 0·01), SR of LCx territories of ≤−0·67 was 75% sensitive and 63% specific (AUC = 0·72, CI = 0·58–0·87, P = 0·02) and SR of RCA territories ≤−0·83 was 73% sensitive and 71% specific (AUC = 0·80, CI = 0·66–0·93, P = 0·001) in predicting significant stenosis. SR was more accurate than all other techniques in predicting the culprit lesion. Conclusion: In ACS, mean regional speckle tracking SR is more sensitive than peak strain, TDI, ECG changes and wall motion abnormalities in detecting significant coronary artery stenosis.
