Abstract
BackgroundSpeckle tracking echocardiography may allow the evaluation of myocardial systolic and diastolic dynamics across different physiologic and pathologic conditions beyond traditional echocardiographic techniques. The use of STE longitudinal strain in identification and risk stratification of CAD has good reproducibility and accuracy. The study aims to detect the relationship between SYNTAX score and global longitudinal peak systolic strain (GLPSS) in patients undergoing coronary angiography, with no history of myocardial infarction.ResultsThe study included 70 symptomatic patients suspected to have chronic coronary syndrome aging 20–80 years (excluding those with significant structural heart disease). All patients underwent clinical evaluation, surface ECG, laboratory assessment, transthoracic echocardiographic (TTE), color TDI tracings, two-dimensional speckle tracking, and conventional coronary angiography with SYNTAX score calculation. Patients were divided into 3 groups based on the results of the coronary angiogram: normal CAD on angiogram (n = 10, control group), low SS (n = 25, SS < 22), and high SS (n = 35, SS ≥ 22).The mean age was 55 ± 9.6 years; 54% were males; two third of patients were hypertensive; 52% were diabetic; high percentage of high syntax score were noticed among males, diabetic patients, and smokers; and also low mean of GLS was noticed among diabetic patients and smokers. There was a statistically significant positive correlation between syntax score and each of LVEDD and LVESD and, on the other hand, statistically significant negative correlation between syntax score and each of E/A, GLS, AP2LS, AP3LS, and AP4LS was noticed. Peak GLS cutoff value of 17.8 and 16.5 showed 84% and 93% sensitivity and 70% and 91% specificity to detect high and low syntax score, respectively.Conclusion2D longitudinal strain analysis has incremental diagnostic value over visual assessment during echocardiography in predicting significant coronary artery disease; GLS may offer a potential sensitive tool to detect significant CAD.
Highlights
Speckle tracking echocardiography may allow the evaluation of myocardial systolic and diastolic dynamics across different physiologic and pathologic conditions beyond traditional echocardiographic techniques
The coronary artery disease (CAD) group has significantly lower AP4 longitudinal strain compared to the control group (13.9 ± 3.5 vs. 19.7 ± 2.9, p < 0.001), lower AP3 longitudinal strain compared to the control group (14.3 ± 3.4 vs. 18.2 ± 2.8, p < 0.001), lower AP2 longitudinal strain compared to the control group (14.1 ± 4 vs. 17.7 ± 3.3, p < 0.01), and lower global longitudinal strain compared to the control group (14.03 ± 2.3 vs. 18.5 ± 1.4, p < 0.001) (Table 1)
Higher SYNTAX score significantly correlated with Left ventricle end-diastolic dimension (LVEDD) and Left ventricle end-systolic dimension (LVESD) (p < 0.001), E/A ratio (p < 0.04), AP2L strain, AP3L strain, AP4L strain, and global longitudinal strain (GLS) (p < 0.001) (Table 1)
Summary
Speckle tracking echocardiography may allow the evaluation of myocardial systolic and diastolic dynamics across different physiologic and pathologic conditions beyond traditional echocardiographic techniques. The use of STE longitudinal strain in identification and risk stratification of CAD has good reproducibility and accuracy. The study aims to detect the relationship between SYNTAX score and global longitudinal peak systolic strain (GLPSS) in patients undergoing coronary angiography, with no history of myocardial infarction. The diagnosis and assessment of chronic coronary syndrome (CCS) involves clinical evaluation, identifying risk factors for atherosclerosis, and specific cardiac investigations such as different stress testing modalities and coronary imaging [1]. Despite the widespread use of imaging and provocative testing, noninvasive identification of patients with CAD remains a clinical challenge; more than half of the patients had normal or non-obstructive CAD on coronary angiography [2]. The diagnosis of CAD using echocardiography mostly depends on the detection of left ventricle (LV) abnormal wall motion and the assessment of LV ejection fraction (EF). Strain can be used in assessing myocardial viability either at rest or with stress [4]
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