Division of Cardiology, Department of Medicine, Feinberg School of Medicine, The Bluhm Cardiovascular Institute, Northwestern University, 626 N. St. Clair Street Suite 600, Chicago, IL 60611, USA.
Eur Heart J Cardiovasc Imaging. 2012 Jul;13(7):579-87. doi: 10.1093/ejechocard/jer282. Epub 2011 Dec 13.
To evaluate the diagnostic power of abnormal global longitudinal strain (GLS) to detect non-obstructive coronary artery disease (CAD) in the resting echocardiogram. GLS using two-dimensional speckle-tracking echocardiography (2D STE) is a powerful tool for detecting advanced CAD. However, the diagnostic power of 2D STE for detecting moderate, clinically unapparent CAD from images obtained at rest is unknown.
We retrospectively studied 2D STE characteristics in 123 consecutive patients who underwent stress echocardiography, and subsequently coronary angiography within 10 days. We compared the diagnostic power of GLS at rest to the conventional wall motion score index (WMSI) during stress for detecting stenosis ≥ 50% (CAD(>50)) in any major coronary artery. Studies with akinetic or dyskinetic segments and reduced left ventricular ejection fraction were excluded. In 56 patients with significant CAD(>50), GLS was -16.77 ± 3.18% compared with -19.05 ± 3.43% in the 67 patients without CAD(<50) (P = 0.0002). A GLS cutpoint of greater than -17.77% had the most optimal sensitivity and specificity (66/76%) for detecting CAD and was comparable to a WMSI ≥ 1.13 (68/70%) measured during stress.
Non-obstructive CAD was identified by a reduced GLS measured by 2D STE in rest images with similar accuracy to the traditional WMSI measured in stress echocardiography.
评估异常整体纵向应变（GLS）在静息超声心动图中检测非阻塞性冠状动脉疾病（CAD）的诊断能力。二维斑点追踪超声心动图（2D STE）的 GLS 是检测晚期 CAD 的有力工具。然而，2D STE 从静息图像中检测中度、临床不明显 CAD 的诊断能力尚不清楚。
我们回顾性研究了 123 例连续患者的 2D STE 特征，这些患者在 10 天内接受了负荷超声心动图检查，并随后进行了冠状动脉造影。我们比较了 GLS 在静息状态下和在应激状态下的常规壁运动评分指数（WMSI）对检测任何主要冠状动脉狭窄≥50%（CAD（>50%）的诊断能力。排除了无运动或运动障碍节段和左心室射血分数降低的研究。在 56 例有明显 CAD（>50%）的患者中，GLS 为-16.77±3.18%，而在 67 例无 CAD（<50%）的患者中为-19.05±3.43%（P=0.0002）。GLS 切点大于-17.77%对检测 CAD 的敏感性和特异性（66/76%）最高，与应激时测量的 WMSI≥1.13（68/70%）相当。
通过二维 STE 在静息图像中测量的降低 GLS 可以识别非阻塞性 CAD，其准确性与传统的应激超声心动图中测量的 WMSI 相似。
