Skip to main content

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


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.


  1. Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, Brindis RG, Douglas PS 2010 Low diagnostic yield of elective coronary angiography. New England Journal of Medicine 362 886–895. (doi:10.1056/NEJMoa0907272)

    Article  CAS  Google Scholar 

  2. Hoit BD 2011 Strain and strain rate echocardiography and coronary artery disease. Circulation. Cardiovascular Imaging 4 179–190. (doi:10.1161/CIRCIMAGING.110.959817)

    Article  Google Scholar 

  3. Smedsrud MK, Sarvari S, Haugaa KH, Gjesdal O, Ørn S, Aaberge L, Smiseth OA, Edvardsen T 2012 Duration of myocardial early systolic lengthening predicts the presence of significant coronary artery disease. Journal of the American College of Cardiology 60 1086–1093. (doi:10.1016/j.jacc.2012.06.022)

    Article  Google Scholar 

  4. Montgomery DE, Puthumana JJ, Fox JM, Ogunyankin KO 2012 Global longitudinal strain aids the detection of non-obstructive coronary artery disease in the resting echocardiogram. European Heart Journal Cardiovascular Imaging 13 579–587. (doi:10.1093/ejechocard/jer282)

    Article  Google Scholar 

  5. Nucifora G, Schuijf JD, Delgado V, Bertini M, Scholte AJ, Ng AC, van Werkhoven JM, Jukema JW, Holman ER, van der Wall EE et al 2010 Incremental value of subclinical left ventricular systolic dysfunction for the identification of patients with obstructive coronary artery disease. American Heart Journal 159 148–157. (doi:10.1016/j.ahj.2009.10.030)

    Article  Google Scholar 

  6. Choi JO, Cho SW, Song YB, Cho SJ, Song BG, Lee SC, Park SW 2009 Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality. European Journal of Echocardiography 10 695–701. (doi:10.1093/ejechocard/jep041)

    Article  Google Scholar 

  7. Gaibazzi N, Rigo F, Reverberi C 2010 Detection of coronary artery disease by combined assessment of wall motion, myocardial perfusion and coronary flow reserve: a multiparametric contrast stress-echocardiography study. Journal of the American Society of Echocardiography 23 1242–1250. (doi:10.1016/j.echo.2010.09.003)

    Article  Google Scholar 

  8. Risum N, Ali S, Olsen NT, Jons C, Khouri MG, Lauridsen TK, Samad Z, Velazquez EJ, Sogaard P, Kisslo J 2012 Variability of global left ventricular deformation analysis using vendor dependent and independent two-dimensional speckle-tracking software in adults. Journal of the American Society of Echocardiography 25 1195–1203. (doi:10.1016/j.echo.2012.08.007)

    Article  Google Scholar 

  9. Sun JP, Lee AP, Wu C, Lam YY, Hung MJ, Chen L, Hu Z, Fang F, Yang XS, Merlino JD et al 2012 Quantification of left ventricular regional myocardial function using two-dimensional speckle tracking echocardiography in healthy volunteers–a multi-center study. International Journal of Cardiology 167 495–501. (doi:10.1016/j.ijcard.2012.01.071)

    Article  Google Scholar 

  10. Negishi K, Lucas S, Negishi T, Hamilton J, Marwick TH 2013 What is the primary source of discordance in strain measurement between vendors: imaging or analysis? Ultrasound in Medicine & Biology 39 714–720. (doi:10.1016/j.ultrasmedbio.2012.11.021)

    Article  Google Scholar 

  11. Burns AT, La Gerche A, D’hooge J, MacIsaac AI, Prior DL 2010 Left ventricular strain and strain rate: characterization of the effect of load in human subjects. European Journal of Echocardiography 11 283–289. (doi:10.1093/ejechocard/jep214)

    Article  Google Scholar 

  12. Cortigiani L, Rigo F, Galderisi M, Gherardi S, Bovenzi F, Picano E, Sicari R 2011 Diagnostic and prognostic value of Doppler echocardiographic coronary flow reserve in the left anterior descending artery in hypertensive and normotensive patients [corrected]. Heart 97 1758–1765. (doi:10.1136/heartjnl-2011-300178)

    Article  Google Scholar 

  13. Biering-Sørensen T, Hoffmann S, Mogelvang R, Zeeberg Iversen A, Galatius S, Fritz-Hansen T, Bech J, Jensen JS 2014 Myocardial strain analysis by 2-dimensional speckle tracking echocardiography improves diagnostics of coronary artery stenosis in stable angina pectoris. Circulation. Cardiovascular Imaging 7 58–65. (doi:10.1161/CIRCIMAGING.113.000989)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Filippo Pigazzani MD.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, 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.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: