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Rest global longitudinal 2D strain to detect coronary artery disease in patients undergoing stress echocardiography: a comparison with wall-motion and coronary flow reserve responses

Echo Research & Practice volume 1, pages 61–70 (2014)Cite this article

Abstract

Myocardium subtended by obstructive coronary artery disease (CAD) may show reduced left ventricle (LV) global longitudinal strain (GLS), as well as early systolic lengthening (ESL) before shortening; these can be measured at rest and may predict obstructive CAD. This study investigated whether baseline resting LV longitudinal strain measurements may be able to detect significant CAD in patients undergoing stress echocardiography (SE) and coronary angiography, who have normal resting wall motion. We selected patients with a clinical indication of coronary angiography who were previously referred for SE. Patients with known CAD, rest wall-motion (WM) abnormalities, or rhythm/conduction abnormalities were excluded. Speckle tracking strain analyses were retrospectively performed on digitally archived 2D video-loops, using vendor independent software. Peak GLS and duration of ESL were recorded. Diagnostic accuracy of each parameter to predict obstructive (≥50%) CAD was assessed and multivariate logistic regression models fitted and compared. Eighty-two patients were enrolled and 49 had significant CAD by quantitative angiography. Patients with CAD were more often male (P=0.01) and more frequently presented with typical angina (P<0.01). Among rest and stress variables, GLS showed a Youden index of 0.665, while SE WM assessment showed a Youden index of 0.599. These were the only two parameters that remained predictive in multivariate analyses. In conclusion, rest GLS demonstrated comparable accuracy with stress-echo data for prediction of angiographically obstructive CAD; it also added significant CAD prediction when combined with clinical data, similar to SE WM assessment.

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Authors and Affiliations

  1. Parma University Hospital, Via Gramsci, 14, 43124, Parma, Italy

    Nicola Gaibazzi MD PhD, Filippo Pigazzani MD & Claudio Reverberi MD

  2. University of Nebraska Medical Center, Omaha, Nebraska, USA

    Thomas R. Porter MD

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  1. Nicola Gaibazzi MD PhD
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  2. Filippo Pigazzani MD
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  3. Claudio Reverberi MD
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  4. Thomas R. Porter MD
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Correspondence to Filippo Pigazzani MD.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://doi.org/creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Gaibazzi, N., Pigazzani, F., Reverberi, C. et al. Rest global longitudinal 2D strain to detect coronary artery disease in patients undergoing stress echocardiography: a comparison with wall-motion and coronary flow reserve responses. Echo Res Pract 1, 61–70 (2014). https://doi.org/10.1530/ERP-14-0020

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  • DOI: https://doi.org/10.1530/ERP-14-0020

Keywords

Echo Research & Practice

ISSN: 2055-0464

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