Detection of Obstructive Coronary Artery Disease Using Peak Systolic Global Longitudinal Strain Derived by Two-Dimensional Speckle-Tracking: A Systematic Review and Meta-Analysis

Liou, Kevin; Negishi, Kazuaki; Ho, Suyen; Russell, Elizabeth; Cranney, G.; Ooi, Sze-Yuan

doi:10.1016/j.echo.2016.03.002

Cited by 77 publications

(61 citation statements)

References 33 publications

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“…37 We and others have shown that patients with coronary disease and preserved LVEF may have reduced GLS. 28,38 The association of rest and moreover peak exercise BLS with cardiac events in our population suggests that even in patients with AS with CAD, BLS is a significantly related to cardiovascular events. The exact pathophysiologic mechanism is unknown.…”

Section: Discussionmentioning

confidence: 83%

The Association Between Longitudinal Strain at Rest and Stress and Outcome in Asymptomatic Patients With Moderate and Severe Aortic Stenosis

Levy-Neuman

Meledin

Gandelman

et al. 2019

Journal of the American Society of Echocardiography

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Background: Calcific aortic stenosis (AS) is a progressive disease, and once moderate AS is present, the likelihood of symptom onset within 5 years is significant. The aim of this study was to determine the incremental value of global longitudinal strain (GLS) and basal longitudinal strain (BLS) at rest and during exercise on outcomes among asymptomatic patients' with moderate and severe AS. Methods: Seventy-five patients with isolated, asymptomatic AS and preserved left ventricular function were retrospectively enrolled and underwent symptom-limited exercise echocardiography. Clinical and echocardiographic data, including GLS and BLS at rest and during exercise, were assessed. Occurrence of ASrelated cardiovascular events was recorded. Results: The mean age was 71 6 10 years, and 63% were men. The mean aortic valve gradient was 30 6 11 mm Hg, and the mean aortic valve area was 0.98 6 0.21 cm 2. Resting GLS and BLS were À16.5 6 4% and À16.9 6 3.6%, respectively. Exercise stress test results were positive in 27 patients (36%). Mean exercise GLS was À17.8 6 3.5%, and mean exercise BLS was À17.9 6 4%. During mean follow-up of 34.5 6 3.5 months, cardiovascular events were observed in 45 patients. In multivariate analysis, aortic valve mean gradient (HR, 1.073; 95% CI, 1.032-1.115; P < .001) and peak exercise BLS (HR, 1.177; 95% CI, 1.07-1.295; P = .001) were associated with cardiac events during follow-up. Conclusions: Reduced exercise BLS is associated with future cardiovascular events in patients' with asymptomatic AS, independently of clinical factors and conventional echocardiographic parameters. Detection of postexercise myocardial dysfunction in patients with asymptomatic AS with preserved left ventricular function can aid in risk assessment of these patients.

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Section: Discussionmentioning

confidence: 83%

The Association Between Longitudinal Strain at Rest and Stress and Outcome in Asymptomatic Patients With Moderate and Severe Aortic Stenosis

Levy-Neuman

Meledin

Gandelman

et al. 2019

Journal of the American Society of Echocardiography

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“…[7][8][9] Longitudinal strain parameters can identify myocardial ischemia caused by significant coronary artery stenosis better than regional wall motion abnormalities assessed visually. [10][11][12] Because dilated cardiomyopathy is caused by myocardial ultrastructural changes rather than oxygen deprivation, 13,14 the pathophysiology of both conditions is different. However, to the best of our knowledge, studies describing differences in myocardial deformation at rest between both populations were not performed.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of two‐dimensional speckle tracking echocardiography to identify ischemic etiology of left ventricular systolic dysfunction

et al. 2019

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Background The differentiation between dilated cardiomyopathy (DCM) and systolic dysfunction caused by coronary artery disease (CAD) based on clinical and echocardiographic presentation can be difficult in some cases. Aim Our study aimed to define differences in myocardial function between patients with ischemic and nonischemic etiology of reduced left ventricular ejection fraction using 2D speckle tracking echocardiography (STE). Material and methods We retrospectively analyzed 90 patients (mean age 65 ± 11 years, 70% male) with de novo diagnosed reduced left ventricular ejection fraction (≤45% as determined by the transthoracic echocardiography), who were referred for coronary angiography to determine the presence of significant CAD. On the basis of coronary angiography results, patients were divided into two subgroups as follows: 45 subjects with significant CAD (group A) and 45 subjects without CAD (group B). Acquired transthoracic echocardiographic images were assessed off‐line using 2DSTE. In each patient, we calculated arithmetic mean, median value, and standard deviation of regional longitudinal strain and strain rate of 18 left ventricular segments. Results Standard deviation of the regional peak early diastolic strain rate was significantly higher in group A than in group B (P = 0.01). The cutoff value with the highest diagnostic value was >0.37/s—its sensitivity and specificity for the diagnosis of CAD were 73% and 53%, respectively. The remaining parameters did not differ significantly between the study groups. Conclusions Patients with systolic dysfunction resulting from CAD have significantly more heterogeneous regional longitudinal early diastolic strain rate assessed by 2DSTE than patients with DCM.

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“…Recently published studies demonstrated that longitudinal myocardial strain imaging with 2D speckle tracking had a diagnostic and prognostic value in patients with acute coronary syndromes [ 7 , 17 ], and it has also been demonstrated as an independent predictor of significant CAD in patients with SAP [ 11 ]. Liou et al [ 18 ] claimed that GLS could be an early marker of CAD in symptomatic patients. Stankovic et al [ 5 ] demonstrated that strain imaging was superior to visual assessment in the detection of LAD stenosis.…”

Section: Discussionmentioning

confidence: 99%

Layer-specific strain analysis in patients with suspected stable angina pectoris and apparently normal left ventricular wall motion

Yılmaztepe

Uçar

2018

Cardiovasc Ultrasound

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BackgroundNon-invasive imaging tests are widely used in the evaluation of stable angina pectoris (SAP). Despite these tests, non-significant coronary lesions are not a rare finding in patients undergoing elective coronary angiography (CAG). Two-dimensional (2D) speckle tracking global longitudinal strain (GLS) imaging is a more sensitive and accurate technique for measuring LV function than conventional 2D methods. Layer-specific strain analysis is a relatively new method that provides endocardial and epicardial myocardial layer assessment. The aim of the present study was to evaluate longitudinal layer-specific strain (LSS) imaging in patients with suspected SAP.MethodsPatients who underwent CAG for SAP were retrospectively screened. A total of 79 patients with no history of heart disease and wall motion abnormalities were included in the study. Forty-three patients with coronary lesions > 70% constituted the coronary artery disease (CAD) group and 36 patients without significant CAD constituted the control group. Layer-specific GLS transmural, endocardium, and epicardium values (GLS-trans, GLS-endo, and GLS-epi, respectively) were compared between the groups.ResultsPatients in the CAD group had significantly lower GLS values in all layers (GLS-trans: -18.2 + 2.4% vs -22.2 + 2.2% p < .001; GLS-endo: -20.8 + 2.8% vs -25.3 + 2.6%, p < .001; GLS-epi: 15.9 + 2.4% vs -19.5 + 1.9%, p < .001). Multivariate adjustment demonstrated GLS-trans as the only independent predictor of CAD [OR:0.472, CI (0.326–0.684), p < .001]. Additionally, the GLS values were all lower in myocardial perfusion scintigraphy (MPS) true-positive patients compared with MPS false-positive patients (GLS-trans: -17.7 ± 2.4 vs. -21.9 ± 2.4%, p < .001; GLS-endo: -20.2 ± 2.9% vs -24.9 ± 2.9%, P < .001; GLS-epi: 15.4 ± 2.6% vs. -19.2 ± 1.8%, P < .001).ConclusionResting layer-specific strain as assessed by 2D speckle tracking analysis demonstrated that GLS values were reduced in all layers of myocardium with SAP and with no wall motion abnormalities. LSS analysis can improve the identification of patients with significant CAD but further prospective larger scale studies are needed to put forth the incremental value of LSS analysis over transmural GLS.

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Detection of Obstructive Coronary Artery Disease Using Peak Systolic Global Longitudinal Strain Derived by Two-Dimensional Speckle-Tracking: A Systematic Review and Meta-Analysis

Cited by 77 publications

References 33 publications

The Association Between Longitudinal Strain at Rest and Stress and Outcome in Asymptomatic Patients With Moderate and Severe Aortic Stenosis

The Association Between Longitudinal Strain at Rest and Stress and Outcome in Asymptomatic Patients With Moderate and Severe Aortic Stenosis

Diagnostic utility of two‐dimensional speckle tracking echocardiography to identify ischemic etiology of left ventricular systolic dysfunction

Layer-specific strain analysis in patients with suspected stable angina pectoris and apparently normal left ventricular wall motion

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