Diagnostic Accuracy Of Global Longitudinal Strain For Detecting Significant Coronary Artery Disease In Diabetic Patients Without Regional Wall Motion Abnormality

Abstract

Aims: 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). Methods: We prospectively studied echocardiographic characteristics at rest with Speckle tracking echocardiography (2D STE) measures; then stress echocardiography and coronary angiography data in 34 diabetic patients without regional wall motion abnormality (RWMA) at rest. Patients were grouped according to coronary angiography and stress echocardiography results into two groups CAD (þ) vs control group CAD (¡). Results: GLS at rest was lower in the CAD (þ) group ((-14.2 % ± 3.1 vs-17.8 % ± 3.1 in the control group CAD (¡), P¼0.004). GLS at rest had the highest area under the ROC curve (AUC) (AUC 0.78, sensitivity 61%, specificity 91%,P¼0.009) with the cutoff of-14.5% which is equal to predictive power of wall motion scoring index (WMSI) at peak stress to detect significant CAD (AUC¼0.76 (95% CI 0.58e0.94, P¼ 0.016) with the cutoff value of 1.21). Conclusions: Global longitudinal strain at rest by STE showed excellent specificity (>90%) and good sensitivity (60%) for the diagnosis of severe CAD among the diabetic population with unknown CAD. This is the first study showing that GLS at rest with cutoff value at-14.5% had good and equal diagnostic accuracy as WMSI at peak stress to detect significant CAD among the diabetic population.

Resting Global Longitudinal Strain as a Noninvasive Diagnostic Tool in Predicting Significant Coronary Artery Disease in Patients with Non-ST-Elevation MI and Normal Left Ventricular Systolic Function on Echocardiography

“…Literature indicates that GLS parameters are highly accurate in predicting CAD and have better sensitivity and specificity compared to traditional methods. 5 Given the subjectivity and variability of wall motion abnormalities and LV EF assessments, there is a need for a more reliable parameter to predict the severity of underlying disease, especially with the increasing burden of CAD and NSTEMI admissions.…”

Four‐dimensional quantification on left atrial volume‐strain in coronary heart disease patients without regional wall motion abnormalities: Correlation with the severity of coronary stenosis

“…For example, researchers have found CHD patients with preserved LVEF demonstrate decreased strain values and increased LV dyssynchrony. [4][5][6] More specifically, in the study performed by Dogdus et al, 7 120 patients with stable angina pectoris were enrolled. Authors figured it out that LV global strain values measured by three-dimensional speckle-tracking echocardiography (3D-STE) were significantly correlated with CHD severity quantified by Gensini score (GS), LV global area strain (GAS) showed an excellent sensitivity (97.2%) and a good specificity (88.1%) to detect the critical CHD.…”

“…In the recent past, the left ventricle (LV) attracted more attention than the other three cardiac chambers in CHD. For example, researchers have found CHD patients with preserved LVEF demonstrate decreased strain values and increased LV dyssynchrony 4–6 . More specifically, in the study performed by Dogdus et al., 7 120 patients with stable angina pectoris were enrolled.…”