Two-dimensional speckle-tracking global longitudinal strain in high-sensitivity troponin-negative low-risk patients with unstable angina: a “resting ischemia test”?

Abstract

With the introduction of high-sensitivity troponin (hsTNI) assays, the clinical significance unstable angina (UA) has become uncertain. We hypothesized that impaired left ventricular (LV) two-dimensional speckle-tracking echocardiography (2D-STE)-derived peak global longitudinal strain (GLS) was able to exclude the presence of significant coronary artery disease (CAD) in UA patients without prior cardiovascular (CV) events and with a normal LV ejection fraction (LVEF). From a cohort of 200 patients admitted with UA, we selected 61 patients without prior CV events and with a normal LVEF; of these, 48 (79%) underwent invasive coronary angiography (ICA) and 24 (39%) had at least ≥ 1 significant stenosis. 2D-STE LV GLS analysis was performed offline using a dedicated automated software program. The mean patient age was 61 ± 12 years and 66% were male. Among the 48 patients selected to undergo ICA, those without significant CAD had a better 2D-STE GLS (- 19.4 vs. - 15.9%, P < 0.001). A cutoff of - 17.5% had a sensitivity of 87% and a specificity of 82% for differentiating UA patients without significant stenosis (AUC 0.86, P < 0.001). Patients who did not undergo ICA had a better GLS (- 20.2 vs. - 17.7%, P = 0.017). 2D-STE GLS had a significantly better discriminative power compared with LVEF (P < 0.001) and the GRACE score (P < 0.001) for identifying patients with significant CAD. Impaired values of 2D-STE LV GLS were significantly associated with the presence of CAD in hsTnI-negative UA patients and demonstrated better discriminative power than LVEF and the GRACE score.

Evaluation of biventricular function in patients with COVID-19 using speckle tracking echocardiography

“…In a study of 61 unstable patients with angina, the LV-GLS value was found to be better in 48 patients who underwent invasive coronary angiography (ICA) and did not have significant coronary artery stenosis (− 19.4 vs. − 15.9%, p < 0.001). Patients who did not undergo ICA had a better LV-GLS value (− 20.2 vs. − 17.7%, p = 0.017) [30]. In our study, LV-GLS was also impaired in patients in the non-severe COVID-19 group with relatively low troponin levels.…”

Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity

“…Echocardiographic examination included tissue Doppler imaging (TDI) and STE analysis of LV, LA, and right ventricular (RV) functions, as previously described [6, 11]. We used a Vivid 7 (GE Healthcare, Horten, Norway) cardiovascular (CV) ultrasound device, with a 1.7/3.4-MHz tissue harmonic transducer.…”

“…We followed to the current recommendations [13, 14] to measure LV size and systolic and diastolic functions. Peak LV-GLS was assessed by STE using a 16-segment model [11, 15].…”

Two‐dimensional speckle‐tracking echocardiographic evaluation of the longitudinal deformation of the left ventricular myocardium in patients with severe coronary artery tortuosity

“…18,19 This technique has also been used to detect reduced longitudinal myocardial deformation due to ischemia. [20][21][22] The measurement of myocardial deformation is better than that of the longitudinal displacement because it is free of tethering effect. 23 Surprisingly, it has been recently demonstrated that myocardial displacement is increased in CAT.…”

“…The ability of two‐dimensional speckle‐tracking echocardiography (2DSTE) to detect myocardial dysfunction in some conditions related to coronary arteries such as the slow‐flow phenomenon and coronary artery ectasia has been demonstrated . This technique has also been used to detect reduced longitudinal myocardial deformation due to ischemia . The measurement of myocardial deformation is better than that of the longitudinal displacement because it is free of tethering effect .…”