# Global longitudinal strain in the prediction of significant coronary artery disease: how accurate is it for patients with a high clinical probability of chronic coronary syndrome and preserved left ventricular ejection fraction?

## TL;DR

This study shows that global longitudinal strain (GLS) from echocardiography is a reliable non-invasive tool for detecting heart artery blockages in patients likely to have chronic heart disease and normal heart pumping.

## Contribution

The study demonstrates GLS's effectiveness in detecting obstructive coronary artery disease in patients with preserved heart function and high clinical suspicion.

## Key findings

- GLS values below -16.9% had 74% sensitivity and 76% specificity for detecting significant coronary lesions.
- GLS correlated with the number of diseased coronary vessels but not with lesion complexity.
- Regional strain was reduced in patients with obstructive lesions in specific arteries like LAD and CX.

## Abstract

GLS is a non-invasive imaging test that can be useful in the selection of patients highly suspected of CCS for coronary angiogram.

This study aimed to evaluate the diagnostic performance of rest 2D speckle tracking echocardiography (2D-STE) for detecting obstructive coronary artery disease (CAD) in patients with high clinical probability of chronic coronary syndrome (CCS) and preserved left ventricular ejection fraction (LVEF).

A prospective study enrolled 52 patients referred for coronary angiography due to highly suspected CCS. Participants were divided into CAD+ (significant stenosis) and CAD- (normal or non-significant stenosis). Transthoracic echocardiography (TTE), exercise EKG, 2D-STE, and coronary angiography were performed. Global longitudinal peak systolic strain (GLS) was calculated using 2D-STE, with a cut-off value of -18% for normal GLS. Reproducibility was assessed with intraclass correlation.

The mean age of participants was 62.5 ± 11.9 years, and 63.5% were male. The CAD + group (51.9%) had significantly higher rates of hypertension, diabetes, dyslipidemia, and typical angina. GLS was significantly lower in the CAD + group (-15.89 ± 2.07%) compared to the CAD- group (-18.99 ± 2.37%, p = 0.0001). The optimal GLS cut-off for detecting significant coronary lesions was − 16.9%, with 74% sensitivity, 76% specificity, and an area under the curve (AUC) of 0.83 (95% CI 0.73–0.94). GLS correlated with the number of diseased vessels (p = 0.0001) but not with lesion complexity (SYNTAX score, p = 0.18). Regional strain was significantly reduced in patients with obstructive lesions in the left anterior descending (LAD) and circumflex arteries (CX), with optimal cut-offs at -19.2% and − 15.8%, respectively. GLS showed excellent inter-operator reproducibility (ICC = 0.94, p < 0.0001).

GLS demonstrates good diagnostic performance in detecting obstructive CAD in patients with a high pre-test probability of CCS and preserved LVEF. It serves as a reliable, reproducible indicator of significant coronary lesions, with promising clinical utility for non-invasive CAD assessment, particularly in resource-limited settings.