Myocardial Strain Analysis by 2-Dimensional Speckle Tracking Echocardiography Improves Diagnostics of Coronary Artery Stenosis in Stable Angina Pectoris

Abstract

Exercise testing is recommended as a first-line diagnostic test in patients with suspected SAP, 9 although the limited sensitivity and specificity have been criticized. 10 Thus, it would be encouraging if 2DSE performed at rest could improve the diagnostic accuracy of the exercise test because both an Background-Two-dimensional strain echocardiography detects early signs of left ventricular dysfunction; however, it is unknown whether myocardial strain analysis at rest in patients with suspected stable angina pectoris predicts the presence of coronary artery disease (CAD). Methods and Results-In total, 296 consecutive patients with clinically suspected stable angina pectoris, no previous cardiac history, and normal left ventricular ejection fraction were included. All patients were examined by 2-dimensional strain echocardiography, exercise ECG, and coronary angiography. Two-dimensional strain echocardiography was performed in the 3 apical projections. Peak regional longitudinal systolic strain was measured in 18 myocardial sites and averaged to provide global longitudinal peak systolic strain. Duke score, including ST-segment depression, chest pain, and exercise capacity, was used as the outcome of the exercise test. Patients with an area stenosis ≥70% in ≥1 epicardial coronary artery were categorized as having significant CAD (n=107). Global longitudinal peak systolic strain was significantly lower in patients with CAD compared with patients without (17.1±2.5% versus 18.8±2.6%; P<0.001) and remained an independent predictor of CAD after multivariable adjustment for baseline data, exercise test, and conventional echocardiography (odds ratio, 1.25 [P=0.016] per 1% decrease). Area under receiver operating characteristic curve for exercise test and global longitudinal peak systolic strain in combination was significantly higher than that for exercise test alone (0.84 versus 0.78; P=0.007). Furthermore, impaired regional longitudinal systolic strain identifies which coronary artery is stenotic. Conclusions-In patients with suspected stable angina pectoris, global longitudinal peak systolic strain assessed at rest is an independent predictor of significant CAD and significantly improves the diagnostic performance of exercise test. Furthermore, 2-dimensional strain echocardiography seems capable of identifying high-risk patients. (Circ Cardiovasc Imaging. 2014;7:58-65.)Key Words: coronary artery disease ◼ diagnostic performance ◼ myocardial ischemia ◼ stable angina pectoris ◼ two-dimensional speckle tracking echocardiography ◼ two-dimensional strain echocardiography

Carotid Artery Intimal-Medial Thickness and Left Ventricular Longitudinal Systolic Strain in Patients with Coronary Artery Disease

“…The present study found that GLS had highly significant positive correlation with EF (r = 0.37, p = 0.001). This result in concordant with results of, Biering-Soerensen et al [17], Evensen et al [18] and Delgado et al [30].…”

“…We found that GLS declined incrementally with increasing severity of CAD defined by increasing number of stenotic coronary vessels. This finding was similar to results of Biering-Soerensen et al [17] and also the studies reported by Gaibazzi et al [20] and Choi et al [22] which showed similar GLS values through different CAD categories. Patients with normal coronaries had a mean GLS of -22 ±1.5%, single or double vessel disease -19.4 ± 2.4 %, and triple-vessel or left main disease -18 ± 2.3%.…”

“…This finding was similar to the results reported by previous studies [15][16][17][18][19][20]. We found that GLS less than -15.8 % may predict of significant obstructive CAD (>70%) in 87.2 % of patients with sensitivity 96.2% and specificity 68.0% as shown Table 3, Figure 2.…”

“…Montgomery et al [16] found that GLS ≤ -17.8 may predict significant obstruction (>50%) of CAD, with sensitivity 66% and specificity 76%. Biering-Soerensen et al [17] showed that cut-off level of GLS was ≤ -18.4% for prediction of significant CAD (>70%) with sensitivity 74% and specificity 58%. Evensen et al [18] found the endocardial strain GLS value less than -16.7% may predict significant obstruction (>50%) of CAD with sensitivity 80% and specificity 60%.…”

Ascending Aortic Strain Analysis Using 2‐Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris

“…SAP was defined as chest pain or discomfort (angina) suspected to be caused by myocardial ischemia 21, 22. Anginal symptoms were considered stable if they had been occurring for several weeks without deterioration and were typically induced by activity or stress 22.…”