Value of resting myocardial deformation assessment by two dimensional speckle tracking echocardiography to predict the presence, extent and localization of coronary artery affection in patients with suspected stable coronary artery disease

Background: Myocardial deformation assessed by two dimensional speckle tracking echocardiography (2D-STE) allows accurate evaluation of regional and global left ventricular (LV) function and is sensitive to detect abnormalities induced by ischemia. Aim: To examine the value of LV strain (S) and strain rate (SR) assessed by STE to detect the presence, and extent of coronary artery affection in patients with suspected stable coronary artery disease (SCAD). Methods: 81 patients with suspected SCAD and normal resting echocardiography were subjected to 2D-STE and coronary angiography. The peak systolic (PS) global longitudinal strain (GLS)/strain rate (GLSR) and PS global radial strain (GRS)/strain rate (GRSR) were calculated as the average of S/SR of the 18 LV segments of the 3 apical views. The PS mid circumferential strain (MCS)/strain rate (MCSR) was calculated as the average of S/SR of the 6 LV segments of the mid LV cavity short axis view. Results: 20 patients (24.7%) represented the normal coronaries group (NCG), and 27 patients (33.3%) with one/two vessel-CAD represented the low risk group (LRG) while 34 patients (42%) with three vessel/left main-CAD represented the high risk group (HRG). GLS, GLSR, GRS, GRSR, MCS and MCSR were significantly lower in patients with significant CAD compared to NCG (all p = 0.000). GLS, GLSR, GRSR, MCS and MCSR were significantly lower in HRG compared to LRG (p = 0.030, p = 0.009, p = 0.000, p = 0.000, and p = 0.004 respectively). Conclusion: Myocardial deformation analysis by STE is not only useful to diagnose CAD, but also predicts the extent of CAD affection in patients with suspected SCAD