How to Avoid a Myocardial Infarction With Radial Wall Strain?
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J INVASIVE CARDIOL 2025. doi:10.25270/jic/24.00369. Epub January 10, 2025.
A 67-year-old man who was overweight, hypertensive, and had no cardiovascular medical history was treated at our center for a lateral myocardial infarction (MI) due to a ramus coronary branch occlusion (Figure A and B). A drug-eluting stent (DES) was implanted, and the final angiographic result was good (Figure C).
Ten months prior, the patient had experienced atypical chest pain, and a coronary angiography and positive computed tomography scan was performed, revealing no angiographically significant lesions. However, non-significant plaques were observed in the left anterior descending artery (LAD) (Figure D) and the ramus branch (Figure E). The patient was treated medically with aspirin and low-dose statin therapy.
Subsequent analysis using radial wall strain (RWS) software (Pulse Medical) determined that the non-significant plaques in the ramus branch were vulnerable with a high risk of MI; the maximum RWS in the ramus branch was 35% (standard < 14%) (Figure F), in contrast to the stable plaques in the LAD with a maximum RWS of 13% (Figure G). If RWS software had been used during the initial coronary angiography, a higher dose of statin therapy could have been introduced. Future randomized trials would be necessary to see if implanting a DES in this situation would have prevented an MI.
The use of RWS could conclusively predict the risk of MI and treat the patient before it occurs, without any significant angiographic coronary artery disease.
Affiliations and Disclosures
Charles Gallen, MD1; Amine Boussofara, MD2; Quentin Landolff, MD1
From the 1Cardiology Department, Clinique Saint-Hilaire, Rouen, France; 2Department of Cardiology, Centre Hospitalier Henri Duffaut, Avignon, France.
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.
Consent statement: The authors confirm that informed consent was obtained from the patient for the study and intervention described in the manuscript and to the publication of their data.
Address for correspondence: Quentin Landolff, Department of Cardiology, Clinique Saint-Hilaire, 2 place Saint-Hilaire, Rouen 76000, France. Email: qlandolff@clinique-sainthilaire.fr, X: @quentinlandolff, LinkedIn: @QuentinLandolff.
