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. 2017 Jun;69(2):95-101.
doi: 10.1016/j.ehj.2016.08.001. Epub 2016 Aug 29.

Value of global longitudinal strain by two dimensional speckle tracking echocardiography in predicting coronary artery disease severity

Hanan Radwan  1 , Ekhlas Hussein  1
Affiliations

Value of global longitudinal strain by two dimensional speckle tracking echocardiography in predicting coronary artery disease severity

Hanan Radwan et al. Egypt Heart J. 2017 Jun.

Abstract

Background: Significant coronary artery stenosis might cause persistently impaired longitudinal left ventricle (LV) function at rest. LV global longitudinal strain (LVGLS) can be accurately assessed by 2D speckle-tracking strain echocardiography(2D-STE).

Objective: We aimed to evaluate the diagnostic accuracy of LV global longitudinal strain obtained by 2D-STE in prediction of severity of CAD.

Methods: Eighty patients with suspected stable angina pectoris were included. They underwent transthoracic echocardiography (TTE) to measure LV ejection fraction, 2-D-STE to measure GLS and coronary angiography (CA). The patients were divided into two groups: group 1 (58 patients) with significant (>70%) CAD, and group 2 (22 patients) with non-significant (<70%) CAD. Images were obtained in the apical long-axis, four-chamber, and two chamber views. Regional longitudinal systolic strain was measured in 17 myocardial segments and averaged to provide global longitudinal strain (LVGLS).

Results: There was significant decrease in GLS in group 1 compared to group 2 (-11.86 ± 2.89% versus -18.65 ± 0.79%, P < 0.000). The optimal cutoff value of GLS for prediction of significant CAD was -15.6% [AUC 0.88, 95% CI 0.78-0.96 p < 0.000]. The sensitivity, specificity and accuracy of GLS for detecting significant CAD were 93.1%, 81.8%,and 90% respectively.There was a significant positive correlation between GLS and EF (r = 0.33; p = 0.036).There was incremental significant decrease in GLS with increasing number of coronary vessels involved.

Conclusion: Measurement of global longitudinal strain using 2D speckle tracking echocardiography is sensitive and accurate tool in the prediction of severe CAD.

Keywords: 2-D speckle tracking echocardiography; 2-DSTE, speckle-tracking strain echocardiography; AVC, aortic valve closure; BMI, body mass index; BSA, body surface area; CA, coronary angiography; CAD; CAD, coronary artery disease; Coronary angiography; DM, diabetes mellitus; DVD, double vessel disease; EDV, end diastolic volume; EF, ejection fraction; ESV, end systolic volume; Global strain; HTN, hypertension; LAD, left anterior descending; LCX, left circumflex; LV, left ventricle; RCA, right coronary artery; SVD, single vessel disease; TTE, transthoracic echocardiography, TVD, triple vessel disease.

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Figures

Figure 1
Figure 1
Left panel demonstrates apical four-chamber view. Corresponding strain curves are shown in the right panel. GLS is normal with strain values of 20.6%. End-systole is defined by aortic valve closure (AVC), and is marked with a vertical green line.
Figure 2
Figure 2
ROC curve for predicting significant CAD using GLS.
Figure 3
Figure 3
Showing positive correlation between GLS and EF.
See this image and copyright information in PMC

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