Applying Resting Global Longitudinal Strain by Two-Dimensional Speckle Tracking as a NonInvasive Diagnostic Tool in Predicting Coronary Artery Disease

Background: Two-dimensional speckle-tracking echocardiography (2D STE) has been used by many cardiologists globally for assessing the left ventricle (LV) function by having global longitudinal strain (GLS) as an important parameter; however, it is not incorporated into daily practice and some studies have proved to be a better diagnostic value for evaluation of detecting significant coronary artery disease (CAD) and also in predicting the culprit coronary artery. Methods: We enrolled 100 consecutive symptomatic patients with suspected CAD who have undergone angiogram in our institute. Out of these, 21 patients had poor echo window and were excluded. The patients were divided into two groups those presenting with acute coronary syndrome ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and others with stable angina. All patients underwent a 2D echocardiogram, 2D strain imaging, and coronary angiogram. Results: GLS correlated well with ejection fraction in our study. GLS was more impaired in patients with double- and triple-vessel disease than in patients with single-vessel disease. The number of patients presented with STEMI is 26 (anterior wall myocardial infarction - 20 and inferior wall myocardial infarction - 6), 23 had NSTEMI, and 30 had stable angina. The results of regional peak systolic strain had a stronger correlation with coronary angiogram in stable angina (P = 0.03), but in ACS patients, it was not significant (P = 0.136). This correlation was better in patients with adequate LV systolic function (P < 0.05) than patients with left ventricular systolic dysfunction (P = 1.0). Conclusion: 2D STE is a simple, noninvasive, and reproducible diagnostic tool in the evaluation of CAD and is immensely helpful in the localization of culprit vessel in chronic coronary syndrome.