Left Atrial Strain for Predicting MACE in NSTEMI

August 28, 2026 updated by: Ahmed Ali Abu Al-Abbass, Assiut University

Incremental Prognostic Value of Left Atrial Reservoir Strain Beyond the GRACE 2.0 Score and Conventional Echocardiographic Parameters for Predicting 6-Month MACE in Patients With NSTEMI

This prospective observational study aims to evaluate whether left atrial reservoir strain, measured by two-dimensional speckle tracking echocardiography, independently predicts 6-month major adverse cardiovascular events (MACE) and provides incremental prognostic value beyond the GRACE 2.0 score, left ventricular ejection fraction, and left atrial volume index in patients with non-ST-elevation myocardial infarction.

Study Overview

Status

Not yet recruiting

Conditions

Detailed Description

Non-ST-elevation myocardial infarction (NSTEMI) carries significant short- and long-term risk of major adverse cardiovascular events despite advances in management. Current risk stratification relies on clinical scores such as GRACE 2.0 and conventional echocardiographic parameters including left ventricular ejection fraction (LVEF) and left atrial volume index (LAVI). These tools have limitations, as LVEF may remain preserved and LAVI mainly reflects chronic remodeling.

Left atrial (LA) reservoir strain assessed by two-dimensional speckle tracking echocardiography is a sensitive marker of left ventricular filling pressure and diastolic function. Reduced LA reservoir strain has been associated with adverse outcomes after NSTEMI, but data on its incremental prognostic value beyond established risk models remain limited.

This prospective observational study will assess whether LA reservoir strain independently predicts 6-month MACE and improves risk discrimination when added to the GRACE 2.0 score and conventional echocardiographic parameters in patients with NSTEMI.

Study Type

Observational

Enrollment (Estimated)

150

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Name: Ahmed A Abu Al-Abbass
Phone Number: 0 10 03702766
Email: ahmed.18313356@med.aun.edu.eg

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

Adult
Older Adult

Accepts Healthy Volunteers

Sampling Method

Non-Probability Sample

Study Population

Adult patients admitted with NSTEMI to the Cardiology Department / Coronary Care Unit of Assiut University Hospital who meet the eligibility criteria.

Description

Inclusion Criteria:

Age > 18 years
Confirmed diagnosis of NSTEMI according to current ESC/ACC guidelines
Willingness to provide informed consent and complete 6-month follow-up
Undergoing coronary angiography or revascularization during the index hospitalization

Exclusion Criteria:

ST-elevation myocardial infarction (STEMI)
Atrial fibrillation or other significant arrhythmia at presentation
Moderate to severe valvular heart disease (especially mitral valve disease)
Prior cardiac surgery or valve replacement
Poor echocardiographic image quality precluding reliable strain analysis
Chronic kidney disease on dialysis
Known cardiomyopathy (hypertrophic, dilated, or infiltrative)
Pregnancy
Refusal to participate

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
6-month major adverse cardiovascular events (MACE) Time Frame: 6 months	Composite of cardiac death, recurrent myocardial infarction, heart failure hospitalization, or life-threatening arrhythmia occurring within 6 months of admission.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Left atrial reservoir strain Time Frame: Baseline	Peak atrial longitudinal strain (PALS) during the reservoir phase measured by two-dimensional speckle tracking echocardiography (EchoPAC software), expressed as percentage (%). Higher values indicate better left atrial function.	Baseline
Change in risk discrimination with addition of LA reservoir strain Time Frame: 6 months	Change in risk discrimination for 6-month MACE when left atrial reservoir strain is added to the GRACE 2.0 score, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI), assessed by change in C-statistic, Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI).	6 months
Optimal cutoff value of LA reservoir strain Time Frame: 6 months	Optimal cutoff value of left atrial reservoir strain for predicting 6-month MACE determined by receiver operating characteristic (ROC) curve analysis.	6 months
Correlation of LA reservoir strain with clinical parameters Time Frame: Baseline	Correlation between left atrial reservoir strain (expressed as percentage) and the following parameters: GRACE 2.0 score, peak troponin level (ng/L), left ventricular ejection fraction (%), and E/e' ratio. Correlation will be assessed using Pearson or Spearman correlation coefficient.	Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Investigators

Study Chair: Hatem A Helmy, prof, Department of Cardiology, Faculty of Medicine, Assiut University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

August 26, 2026

Primary Completion (Estimated)

August 26, 2027

Study Completion (Estimated)

May 25, 2028

Study Registration Dates

First Submitted