P1462 Additive value of global longitudinal strain measurement in patients with known or suspected ischaemic heart disease undergoing stress echo

Abstract

Abstract BACKGROUND Speckle-tracking echocardiography (STE) can be applied in a large variety of clinical conditions. Global longitudinal strain (GLS) shows high diagnostic accuracy for the detection of myocardial ischemia as it reflects changes in subendocardial fibers deformation that are more exposed to ischemic damage, even before alterations in segmental kinetics are revealed. PURPOSE Aim of our study was to assess whether the measurement of global longitudinal strain during stress-echo can provide additional information compared to the assessment of conventional parameters such as left ventricular ejection fraction (LVEF) and wall motion abnormalities. We also evaluated the added value of strain in patients with complete (CRP) and incomplete revascularization (IRP). METHODS We enrolled 69 patients, 39 with known (IHD) and 30 with suspected ischaemic heart disease (SIHD) with indication to perform a stress echocardiogram. Inclusion criteria were: known or suspected CAD, age <85 and >18, adeguate acoustic window. Cardiological evaluation and stress echo were performed in all patients. Primary end point was evaluating whether in patients with negative stress test the presence of reduced GLS identifies patients with an adverse prognosis at follow up and to assess if in IRP and negative stress test there is evidence of left subclinical ventricular dysfunction identifiable by GLS analysis compared to CRP. RESULTS LVEF was significantly reduced in IHD patients compared to SIHD patients (54 ± 7vs 60 ± 4 at rest; 55 ± 8vs62 ± 3 at peak; p < 0.0001). We also observed a significant reduction of GLS in IHD patients compared to SIHD patients (-16.7 ± 4,3vs-19 ± 2.2 - p = 0.07 at rest, -18 ± 4.6vs22 ± 3.4-p = 0.004 at peak). In CRP patients GLS did not change significantly with a tendency to improve (-17.6 ± 4 at rest vs -19 ± 4.5 at peak - p = 0.4). Instead in IRP patients, significant reduction of GLS was observed at peak (17.5 ± 0.7 at rest vs 14.2 ± 0.3 at peak, p value 0,03). LVEF did not significantly differ in CRP (54 ± 5 at baseline vs 55 ± 7 at peak, p = 0.5) and IRP (52 ± 9 at baseline vs. 52 ± 9 at peak, p = 0.9) . CONCLUSIONS Our study shows that strain analysis during stress echocardiography can provide additional information in identifying a subclinical reduction of myocardial function at baseline and a reduction in contractile reserve under stress, secondary to coronary flow reduction. Being GLS a powerful prognostic marker probably patients with negative stress test and incomplete revascularization, reduced baseline GLS and reduction of GLS at peak exercise represent a population at higher risk of coronary artery disease progression and development of left ventricular dysfunction who need a closer follow up. To verify our hypothesis we plan to increase our sample size and to prospectively follow up our patients.