Predictive value of global and territorial longitudinal strain imaging in detecting significant coronary artery disease in patients with myocardial infarction without persistent ST ‐segment elevation

Two‐dimensional (2D) speckle‐tracking echocardiographic ( STE ) imaging is frequently performed in the assessment of cardiovascular diseases. We aim to investigate the role of the global and territorial longitudinal strain ( GLS and TLS ) values assessed via 2D STE imaging to detect significant coronary artery disease ( CAD ) in non‐ ST ‐segment elevation myocardial infarction ( NSTEMI ) patients without wall‐motion abnormalities. Methods This study enrolled 150 patients with the diagnosis of NSTEMI . Patients who had typical chest pain with unstable angina characteristics within the last 24 hours were 18–80 years of age and had a typical rise and/or fall of cardiac biomarkers were included. Myocardial functions were assessed via myocardial deformation analyses of 2D STE images. Results The mean age of the CAD group was 52.91 ± 9.11, vs 50.31 ± 8.32 in the control group. In the CAD group, 56 patients were male (65%), whereas 21 were male (60%) in control group. GLS and TLS assessments demonstrated a statistically significant difference between CAD and control groups, with GLS values of −16.27 ± 1.91 and −18.74 ± 1.93 ( P  <   0.001), TLS ‐ LAD values of −15.67 ± 1.83 and −18.54 ± 1.97 ( P  <   0.001), TLS ‐ RCA values of −17.04 ± 1.81 and −19.20 ± 1.86 ( P  <   0.001), and TLS ‐Cx values of −17.40 ± 2.08 and −18.34 ± 2.18 ( P  =   0.028), respectively. Correlation analyses revealed that as high‐sensitivity troponin (hsTnT) values increased, GLS decreased significantly, and further, an increase in severity of CAD resulted in decreased TLS ‐ LAD , ‐ CX and ‐ RCA ( TLS ‐ LAD : P  <   0.001, r  = −0.743; TLS ‐ CX : P  <   0.001, r  = −0.449; TLS ‐ RCA : P  <   0.001, r  = −0.737). Multivariate analyses indicated that GLS and GRACE ACS risk scores are independent predictors of CAD in patients with NSTEMI ( GLS : OR  = 0.514, P  < 0.001; GRACE score: OR  = 0.938, P  = 0.007). Conclusions Global longitudinal strain ( GLS ) assessed with 2D STE is a promising, easy to perform and quick imaging method to predict CAD in patients with NSTEMI .