Layer‐specific global longitudinal strain reveals impaired cardiac function in patients with reversible ischemia

Aims Two‐dimensional speckle tracking echocardiography (2 DSTE ) detects early signs of left ventricular dysfunction; however, it is unknown whether layer‐specific global longitudinal strain ( GLS ) has incremental value in diagnosis of patients with reversible ischemia assessed by single photon emission computed tomography ( SPECT ). Methods and Results Eighty patients with stable angina pectoris ( SAP ), normal left ventricular ejection fraction ( LVEF ), and no history of ischemic heart disease were retrospectively identified to have been examined by 2 DSTE , SPECT , and coronary angiography ( CAG ). Patients with a normal SPECT constituted the control group, and patients with a positive SPECT were divided into patients with or without (true‐ or false‐ positive SPECT ) significant stenosis assessed by CAG . GLS was measured for two myocardial layers (endocardial and epicardial) and as well as mid‐myocardial GLS . Patients with reversible ischemia had significantly lower GLS compared to the control group ( GLS E ndocardial : −19.0 ± 4.4% vs −21.4 ± 3.7%, P  = .011; GLS E picardial : −14.3 ± 2.9% vs −16.3 ± 2.9%, P  = .004); GLS M id‐myocardial : −16.5 ± 3.6% vs −18.6 ± 3.2%, P  = .006. This difference was even more evident in patients with a true‐positive SPECT ( GLS E ndocardial : −18.0 ± 4.4% vs −21.4 ± 3.7%, P  < .001; GLS E picardial : −13.6 ± 3.0% vs −16.3 ± 2.9%, P  < .001); GLS M id‐myocardial : −15.6 ± 3.6% vs −18.6 ± 3.2%, P  < .001. Notably, no significant differences existed in patients with a false‐positive SPECT . GLS E picardial was the only independent predictor of coronary artery disease. In conclusion In patients with SAP and preserved LVEF , layer‐specific GLS at rest identifies patients with reversible ischemia. This seems to be evident only in patients with a true‐positive SPECT , thus, 2 DSTE at rest might improve the diagnostic accuracy of a positive SPECT .