Efficacy of longitudinal speckle tracking strain in conjunction with isometric handgrip stress test for detection of ischemic myocardial segments

Abstract

Background: Isometric handgrip stress test is a simple method for detecting coronary artery disease (CAD). However, the value of this method alone is limited by relatively low sensitivity. This study thus aimed to investigate the usefulness of two-dimensional speckle-tracking strain combined with handgrip for CAD patients.

Method: We studied 35 patients with stable angina pectoris who underwent percutaneous coronary intervention (PCI). Longitudinal (L-ɛ) and transverse peak systolic (T-ɛ) strains were measured from three standard apical views before and 1 month after PCI. Segments corresponded to perfusion territories of coronary arteries were divided into two groups based on coronary angiography results: stenotic (S) and nonstenotic (NS) segment.

Results: L-ɛ in S segments increased significantly after PCI, from -15.8% to -17.6% (P < 0.01), but not in NS segments. Moreover, L-ɛ in S segments increased significantly during handgrip before PCI, from -15.8% to -17.6% (P < 0.01), but decreased after PCI, from -17.6% to -16.7% (P = 0.02). In contrast, L-ɛ in NS segments decreased significantly during the isometric handgrip stress test before and after PCI (P < 0.05). Especially noteworthy is that a relative change in L-ɛ of >1.2% during handgrip before PCI could detect significant coronary stenosis with a sensitivity of 80%, specificity of 66%, and area under the curve of 0.77 (P < 0.001). On the other hand, no significant changes were observed in either T-ɛ segments during handgrip either before or after PCI.

Conclusion: Longitudinal speckle-tracking strain combined with handgrip may constitute a valuable tool for detection of ischemic myocardial segments and prediction of improvement of regional contraction after revascularization.