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Background Early detection of myocardial ischemia has important therapeutic and prognostic implications. Evidence of post-systolic shortening (PSS) on speckle tracking TTE is indicative of delayed myocardial contraction after aortic valve closure (AVC), and has been proposed to be a marker of myocardial ischemia. The pathologic post systolic strain index (PSI) only exists in patients with decreased systolic strain and thickening. Purpose To evaluate the PSI and time interval from AVC to regional PLS measured by using resting 2D speckle tracking TTE for detection of LV myocardial ischemic segments and lesion severity confirmed by coronary angiography. Methods A cross sectional study of patients with ischemic heart disease, underwent 2D speckle tracking TTE (Vivid E9, GE Healthcare) immediately before invasive coronary angiography. PSI, regional PLS and time interval from AVC to regional PLS in each LV segment were calculated. Results 63 stable patients, the mean age 55.6 (± 10.95) years and male: female ratio (2: 1). Coronary angiographic lesion ≥ 50% was detected in (334) LV segments of corresponding coronary artery territory. There were significant differences between LV segments with &amp;lt;50% CA lesion severity and LV segments with ≥50% CA lesion severity regarding both the PSI and Time interval from AVC to regional PLS. To identify the LV segments of the corresponding CA territory with ≥50% lesion severity, the receiver operator characteristic (ROC) curves for PSI and the time interval had areas under the curve (AUC) values 0.82 and 0.63 respectively which were statistically significant with best cut-off points of PSI was 15% (sensitivity 84%, specificity 68%) and for the Time interval was 85msec (sensitivity 68%, specificity 55%). Conclusion In ischemic patients with ≥50% coronary artery stenosis, as confirmed by invasive coronary angiography, the measurement of PSI and the time interval simultaneously on resting 2D ST_TTE, enabled the identification of LV segments of the corresponding coronary artery territory with pathologic (ischemic) PSS by using each appropriate threshold for PSI and time interval with excellent diagnostic accuracy. When both measures were significant, the sensitivity and specificity being (49 %, 69.8%) respectively which is better than using one measure alone. Best cut-off point of PSI &amp; Time interva variable cut-off point sensitivity specificity PSI 15% 84% 68% Time Interval 68% 55% PSI &amp; Time Interval 15% , 85 msec 49% 69.8%

european heart journal. cardiovascular imaging

P1549 The quantitative value of PSI and time interval between AV closure and regional peak longitudinal strain in the assessment of CAD severity by the use of resting 2D ST_TTE