Skip to main content

Correlation between global longitudinal peak systolic strain and coronary artery disease severity as assessed by the angiographically derived SYNTAX score


Background In this study, we investigate the correlation between reduced global longitudinal peak systolic strain (GLPSS) and the SYNTAX score (SS) in patients undergoing coronary angiography.

Methods: We examined 71 patients undergoing both echocardiogram and coronary angiography within 15 days. All patients had normal global and/or regional wall motion on resting echocardiogram. We calculated GLPSS using two-dimensional speckle-tracking echocardiography. SS was calculated for each group of patients based on the presence and/or the severity of coronary artery disease (CAD): no CAD on angiogram (n=10, control group), low SS (n=36, SS<22) and high SS (n=25, SS≥22). We hypothesised that GLPSS at rest is inversely correlated with the angiographically derived SS.

Age, sex and most of the risk factors were equally distributed among the groups. There was a significant inverse correlation between GLPSS and SS values (r2=0.3869, P<0.001). This correlation was weaker in the low-SS group (r2=0.1332, P<0.05), whereas it was lost in the high-SS group (r2=0.0002, P=NS). Receiver operating characteristic curve analysis identified that the optimal cut-off for the detection of high-SS patients was 13.95% (sensitivity=71%, specificity=90%, P<0.001).

Conclusions: The results of our study suggest that GLPSS might be promising for the detection of patients with high SYNTAX score on coronary angiogram. There is an inverse correlation between resting GLPSS and SS as assessed by coronary angiography. In patients with the highest SS, however, the correlation with GLPSS was less significant.


  1. Nesbitt GC, Mankad S & Oh JK 2009 Strain imaging in echocardiography: methods and clinical applications. International Journal of Cardiovascular Imaging 25 (Supplement 1) 9–22. (doi:10.1007/s10554-008-9414-1)

    Article  Google Scholar 

  2. Elhendy A, van Domburg RT, Bax JJ & Roelandt JR 2000 Significance of resting wall motion abnormalities in 2-dimensional echocardiography in patients without previous myocardial infarction referred for pharmacologic stress testing. Journal of the American Society of Echocardiography 13 1–8. (doi:10.1016/s0894-7317(00)90036-1)

    Article  CAS  Google Scholar 

  3. Jamal F, Sutherland GR, Weidemann F, D’hooge J, Bijnens B & Derumeaux G 2002 Can changes in systolic longitudinal deformation quantify regional myocardial function after an acute infarction? An ultrasonic strain rate and strain study. Journal of the American Society of Echocardiography 15 723–730. (doi:10.1067/mje.2002.118913)

    Article  Google Scholar 

  4. Williams RI, Payne N, Phillips T, D’hooge J & Fraser AG 2005 Strain rate imaging after dynamic stress provides objective evidence of persistent regional myocardial dysfunction in ischaemic myocardium: regional stunning identified? Heart 91 152–160. (doi:10.1136/hrt.2003.027490)

    Article  CAS  Google Scholar 

  5. Liang HY, Cauduro S, Pellikka P, Wang J, Urheim S, Yang EH, Rihal C, Belohlavek M, heria B, Miller FA, et al. 2006 Usefulness of two-dimensional speckle strain for evaluation of left ventricular diastolic deformation in patients with coronary artery disease. American Journal of Cardiology 98 1581–1586. (doi:10.1016/j.amjcard.2006.07.038)

    Article  Google Scholar 

  6. 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 

  7. Eek C, Grenne B, Brunvand H, Aakhus S, Endresen K, Smiseth OA, Edvardsen T & Skulstad H 2010 Strain echocardiography predicts acute coronary occlusion in patients with non-ST-segment elevation acute coronary syndrome. European Journal of Echocardiography 11 501–508. (doi:10.1093/ejechocard/jeq008)

    Article  Google Scholar 

  8. Gjesdal O, Helle-Valle T, Hopp E, Lunde K, Vartdal T, Aakhus S, Smith HJ, Ihlen H & Edvardsen T 2008 Noninvasive separation of large, medium, and small myocardial infarcts in survivors of reperfused ST-elevation myocardial infarction: a comprehensive tissue Doppler and speckle-tracking echocardiography study. Circulation Cardiovascular Imaging 1 189–196. (doi:10.1161/CIRCIMAGING.108.784900)

    Article  Google Scholar 

  9. 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 

  10. 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 13 579–87. (doi:10.1093/ejechocard/jer282)

    PubMed  Google Scholar 

  11. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al., 2015 Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal: Cardiovascular Imaging 16 233–270. (doi:10.1093/ehjci/jev014)

    PubMed  Google Scholar 

  12. Tanaka H, Chikamori T, Hida S, Igarashi Y, Shiba C, Usui Y, Hatano T & Yamashina A 2013 Relationship of SYNTAX score to myocardial ischemia as assessed on myocardial perfusion imaging. Circulation Journal 77 2772–2777. (doi:10.1253/circj.cj-13-0099)

    Article  Google Scholar 

Download references


We deeply thank the Foundation for Education and European Culture in Greece for the help and financial support, which made this research possible.


This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author information

Authors and Affiliations


Rights and permissions

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as 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

Verify currency and authenticity via CrossMark

Cite this article

Vrettos, A., Dawson, D., Grigoratos, C. et al. Correlation between global longitudinal peak systolic strain and coronary artery disease severity as assessed by the angiographically derived SYNTAX score. Echo Res Pract 3, 29–34 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key Words

  • speckle-tracking echocardiography
  • coronary artery diseasep