Longitudinal 2D Strain at Rest Predicts the Presence of Left Main and Three Vessel Coronary Artery Disease in Patients Without Regional Wall Motion Abnormality

Aims: Non-invasive echocardiographic detection of coronary artery disease (CAD), even in left main or three-vessel CAD, usually requires a stress test since regional wall motion abnormalities (RWMA) are not always evident at rest. Strain is a more sensitive parameter of myocardial systolic function and may be abnormal in patients with severe CAD.

Methods And Results: We evaluated whether peak systolic longitudinal strain (PSLS) of left ventricle using 2D speckle tracking method might be useful for screening of severe CAD. One hundred and eight patients who underwent echocardiography and coronary angiography were evaluated. Patients were grouped according to the coronary angiographic findings as follows; high-risk group with left main or three-vessel CAD (n = 38), low-risk group with one- or two-vessel CAD (n = 28), and control group without CAD (n = 30). PSLSs of all left ventricular segments were obtained successfully in 96 (89%) patients. None had RWMA at resting echocardiogram. PSLS was significantly reduced, especially in mid- and basal segments, in the high-risk group. Receiver operating characteristic (ROC) curve analysis demonstrated that mid- and basal PSLSs could effectively detect patients with severe CAD (area under ROC curve = 0.83, 95% CI 0.75-0.91). According to ROC curve analysis, -17.9% appears to be a helpful cutoff value for discriminating those with severe CAD (specificity 79% and sensitivity 79%).

Conclusion: PSLS at rest was significantly lower in patients with left main or three-vessel CAD without RWMA, and might be useful for identifying patients with a severe CAD.