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.
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
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
Adult patients admitted with NSTEMI to the Cardiology Department / Coronary Care Unit of Assiut University Hospital who meet the eligibility criteria.
Cohort
Prospective
Not listed
6-month major adverse cardiovascular events (MACE)
Composite of cardiac death, recurrent myocardial infarction, heart failure hospitalization, or life-threatening arrhythmia occurring within 6 months of admission.
Left atrial reservoir strain
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.
Change in risk discrimination with addition of LA reservoir strain
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).
Optimal cutoff value of LA reservoir strain
Optimal cutoff value of left atrial reservoir strain for predicting 6-month MACE determined by receiver operating characteristic (ROC) curve analysis.
Correlation of LA reservoir strain with clinical parameters
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.
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