Global longitudinal strain in the prediction of significant coronary artery disease: how accurate is it for patients with a high clinical probability of chronic coronary syndrome and preserved left ventricular ejection fraction?

BACKGROUND

GLS is a non-invasive imaging test that can be useful in the selection of patients highly suspected of CCS for coronary angiogram.

AIMS

This study aimed to evaluate the diagnostic performance of rest 2D speckle tracking echocardiography (2D-STE) for detecting obstructive coronary artery disease (CAD) in patients with high clinical probability of chronic coronary syndrome (CCS) and preserved left ventricular ejection fraction (LVEF).

METHODS

A prospective study enrolled 52 patients referred for coronary angiography due to highly suspected CCS. Participants were divided into CAD+ (significant stenosis) and CAD- (normal or non-significant stenosis). Transthoracic echocardiography (TTE), exercise EKG, 2D-STE, and coronary angiography were performed. Global longitudinal peak systolic strain (GLS) was calculated using 2D-STE, with a cut-off value of -18% for normal GLS. Reproducibility was assessed with intraclass correlation.

RESULTS

The mean age of participants was 62.5 ± 11.9 years, and 63.5% were male. The CAD + group (51.9%) had significantly higher rates of hypertension, diabetes, dyslipidemia, and typical angina. GLS was significantly lower in the CAD + group (-15.89 ± 2.07%) compared to the CAD- group (-18.99 ± 2.37%, p = 0.0001). The optimal GLS cut-off for detecting significant coronary lesions was - 16.9%, with 74% sensitivity, 76% specificity, and an area under the curve (AUC) of 0.83 (95% CI 0.73-0.94). GLS correlated with the number of diseased vessels (p = 0.0001) but not with lesion complexity (SYNTAX score, p = 0.18). Regional strain was significantly reduced in patients with obstructive lesions in the left anterior descending (LAD) and circumflex arteries (CX), with optimal cut-offs at -19.2% and - 15.8%, respectively. GLS showed excellent inter-operator reproducibility (ICC = 0.94, p < 0.0001).

CONCLUSION

GLS demonstrates good diagnostic performance in detecting obstructive CAD in patients with a high pre-test probability of CCS and preserved LVEF. It serves as a reliable, reproducible indicator of significant coronary lesions, with promising clinical utility for non-invasive CAD assessment, particularly in resource-limited settings.