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Utility of global longitudinal strain to detect significant coronary artery disease, its extent and severity in patients with stable ischemic heart disease
Author(s) -
Biswas Kaushik,
Mukherjee Anindya,
Nandi Saumen,
Khanra Dibbendhu,
Sharma Ranjan Kumar,
Maji Sujata
Publication year - 2020
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14908
Subject(s) - medicine , cardiology , coronary artery disease , angina , cutoff , strain (injury) , correlation , disease , myocardial infarction , quantum mechanics , physics , geometry , mathematics
Background Early changes in cardiac function due to ischemia may be detected by global longitudinal peak systolic strain (GLS). Till date, no Indian data exist regarding role of GLS in stable ischemic heart disease (SIHD) and data showing correlation of GLS and SYNTAX score (SS) is meager in world literature. Our aim was to ascertain the role of GLS in SIHD. Methods One hundred and seventeen subjects with angina and normal transthoracic echocardiogram (TTE) underwent strain echocardiography and coronary angiography (CAG). Results There was significant correlation between GLS and SS values ( R 2 = .686, P < .0001). The correlation was weaker yet significant in the low SS (<22) group ( R 2 = .491, P < .0001) and high SS (≥22) group ( R 2 = .602, P < .0001). The cutoff value of GLS to detect significant CAD was −16.5 (87.6% sensitivity, 85.7% specificity, P < .0001), to predict high SS was −13.5% (sensitivity 78.3%, specificity 87.9%, P < .0001) and to predict triple vessel disease (TVD) was −14.5 (95.7% sensitivity, 73.4% specificity, P < .0001). The agreement between GLS and CAG for detection of significant CAD was substantial ( κ = 0. 676, P < .0001), similar to that between territorial strain and CAG in detecting LAD disease ( κ = 0.688, P < .0001) while agreement between strain imaging and CAG for detecting number of vessels diseased was moderate ( κ = 0.406, P < .0001). Conclusion Global longitudinal peak systolic strain must be conducted on subjects with angina and inconclusive electrocardiogram (ECG) findings to rule out significant CAD even if conventional TTE was normal. This may facilitate early diagnosis of CAD or sub‐clinical left ventricular systolic dysfunction (LVSD), preventive or treatment measures, and overall cost savings.