Diagnostic accuracy of Global Longitudinal Strain for detecting significant coronary artery disease in diabetic patient without regional wall motion abnormality

Abstract

Speckle-tracking imaging is a novel method for assessing left ventricular (LV) function and ischemic changes. The aim of this prospective study was to assess the diagnostic accuracy of global longitudinal strain (GLS) and regional longitudinal strain (RLS) parameters at rest in comparison to stress echocardiography findings for detecting significant coronary artery disease (CAD) in patients with diabetes mellitus (DM). We prospectively studied echocardiographic characteristics at rest with Speckle-tracking echocardiography (2D STE) measures; then stress echocardiography and coronary angiography in 34 diabetic patients without regional wall motion abnormality (RWMA). Patients were grouped according to coronary angiography and stress echocardiography results into two groups CAD (+) vs. control group CAD (−). GLS at rest was lower in the CAD (+) group (−14.2% ± 3.1 vs. −17.8% ± 3.1, P = 0.004). GLS at rest had the highest area under the ROC curve (AUC) (AUC 0.78, sensitivity 61%, specificity 91%) with the cut-off of −14.5%, which is equal to predictive power of wall motion scoring index (WMSI) at peak stress to detect significant CAD [AUC = 0.76 (95% CI: 0.58–0.94, P , 0.016), cut-off value = 1.21]. Global longitudinal strain at rest is highly sensitive and specific in detecting hemodynamically significant coronary artery stenosis in diabetic patients with unknown CAD. This is the first study showing that GLS at rest with cut-off value at −14.5% had good and equal diagnostic accuracy as WMSI at peak stress to detect significant CAD among patients with diabetes mellitus.