Speckle Tracking Echocardiography: Early Predictor of Diagnosis and Prognosis in Coronary Artery Disease

Abstract

Echocardiography represents a first level technique for the evaluation of coronary artery disease (CAD) which supports clinicians in the diagnostic and prognostic workup of these syndromes. However, visual estimation of wall motion abnormalities sometimes fails in detecting less clear or transient myocardial ischemia and in providing accurate differential diagnosis. Speckle tracking echocardiography (STE) is a widely available noninvasive tool that could easily and quickly provide additive information over basic echocardiography, since it is able to identify subtle myocardial damage and to localize ischemic territories in accordance to the coronary lesions, obtaining a clear visualization with a “polar map” useful for differential diagnosis and management. Therefore, it has increasingly been applied in acute and chronic coronary syndromes using rest and stress echocardiography, showing good results in terms of prediction of CAD, clinical outcome, left ventricular remodeling, presence, and quantification of new/residual ischemia. The aim of this review is to illustrate the current available evidence on STE usefulness for the assessment and follow-up of CAD, discussing the main findings on bidimensional and tridimensional strain parameters and their potential application in clinical practice.

Left Ventricular Longitudinal Strain Echocardiogram and Handgrip: A Useful Tool for Detecting Ischemia in the Emergency Room

“…The fibers of the subendocardial layer, the most susceptible to ischemia, are arranged longitudinally, so the GLS here is expected to be the most sensitive for the evaluation of ischemic segments as it is the first to change. 1,3,4 In addition, strain on ECHO can be a marker of myocardial fibrosis, enabling the diagnosis of post-ischemic myocardial scarring. 4 The 2019 positioning on ECHO indications for adults suggests GLS calculation using the existing diagnostic algorithms and risk classification in patients with suspected coronary disease as recommendation class IIa, evidence level B.…”

“…1,3,4 In addition, strain on ECHO can be a marker of myocardial fibrosis, enabling the diagnosis of post-ischemic myocardial scarring. 4 The 2019 positioning on ECHO indications for adults suggests GLS calculation using the existing diagnostic algorithms and risk classification in patients with suspected coronary disease as recommendation class IIa, evidence level B. 5 In addition to the peak systolic value of the strain, evaluation of the post-systolic contraction peak, consisting of continued contraction of the myocardium after aortic valve closure, is also used.…”

“…The method has an established role in chest pain patients with a low probability of acute CAD after an observation period without ECG and marker changes, which also have a prognostic role in the evaluation of ventricular function at rest and under stress, cavity dilation, development of dysfunction diastolic, right ventricular dysfunction etc. 4 The handgrip is a safe complementary technique to dobutamine stress ECHO that can also help diagnose ischemia. Simple to perform, it consists of isometric muscle contraction and increases systolic blood pressure and HR through increased peripheral vascular resistance and sympathetic nervous system activation.…”

Algorithmic Approaches in Diagnostic Decision Support for Combined Use of Speckle-Tracking Echocardiography and Coronary Angiography in Patients with Coronary Artery Disease

“…Удосконалення методів діагностики ІХС передбачає визначення найбільш інформативних та менш коштовних методів її ранньої діагностики. Сьогодні для більш ранньої первинної діагностики ішемії міокарда у хворих з ІХС та підвищення її чутливості й специфічності широко використовується ультразвуковий аналіз деформації у В-режимі, або спекл-трекінг (СТЕ) ехокардіографія (ЕхоКГ) [1][2][3][4][5][6][7], яка дає змогу проводити ранню діагностику ішемії міокарда часто на доклінічному етапі та кращу стратифікацію хворих зі стабільними та нестабільними формами ІХС щодо їх реваскуляризації [2][3][4][5]. Це допомагає краще верифікувати амбівалентні результати коронарної ангіографії (КАГ) або краще визначити показання до її проведення та реваскуляризації міокарда.…”

Post-systolic shortening is superior to global longitudinal strain in predicting adverse events in patients with stable coronary artery disease and preserved systolic function

“…1 ) > 20%. The superiority of PSS to conventional parameters in detecting acute ischemia and predicting adverse cardiovascular events has been indicated in clinical studies [ 11 , 12 ]. Interestingly, among the myocardial deformation parameters derived from STE, PSS is sometimes observed without a relative strain decrease in the acute ischemic region, especially after recovery from ischemia [ 13 ].…”