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Updated: Jul 4, 2025
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
The possible utility of global longitudinal strain in the risk-stratifying process of non-ST elevation-acute coronary
Ahmed Fouad1,2, Elsayed Mohamad Farag3, Hisham Samir Roshdy3
1Salalah Heart Center, Salalah, Oman.
Insights
Left ventricular global longitudinal strain (LV-GLS) accurately predicts high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). This echocardiographic measure aids in stratifying risk for better patient management and treatment decisions.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Imaging
Background:
- Coronary artery disease (CAD) presents variably.
- Risk stratification is crucial for non-ST-elevation acute coronary syndrome (NSTE-ACS) patients to guide invasive strategies.
Purpose of the Study:
- To evaluate the utility of left ventricular global longitudinal strain (LV-GLS) in risk stratification for NSTE-ACS patients.
- To determine if LV-GLS can improve the accuracy of risk assessment in NSTE-ACS.
Main Methods:
- Cross-sectional study of 90 NSTE-ACS patients meeting European Society of Cardiology (ESC) guidelines.
- Assessment included clinical examination, ECG, hs-TnT, GRACE risk score, and transthoracic echocardiography with 2D speckle tracking (2D-ST) for LV-GLS measurement.
- SYNTAX Score was also determined for all participants.
Main Results:
- LV-GLS demonstrated high accuracy in predicting high-risk NSTE-ACS patients based on the GRACE score.
- A cutoff of ≥-13.8 for LV-GLS yielded an Area Under the Curve (AUC) of 0.944, with high sensitivity (94.4%) and specificity (93.3%).
- The accuracy for predicting high-risk status was 85.6%.
Conclusions:
- Left ventricular global longitudinal strain is a valuable and accurate predictor of high-risk NSTE-ACS patients.
- LV-GLS can effectively complement existing risk scores like GRACE for improved patient stratification.
- Echocardiographic assessment of LV-GLS offers a non-invasive method to guide clinical decisions in NSTE-ACS management.
Background:
There are various ways that coronary artery disease (CAD) might present itself. Individual risk stratification for non ST-elevation-acute coronary syndrome (NSTE-ACS) patients should determine whether invasive coronary angiography and revascularization should be scheduled.
Aim Of Work:
To assess the possible utility of left ventricular global longitudinal strain in the risk-stratifying process of NSTE-ACS.
Subjects And Methods:
The cardiology department of Zagazig University in Egypt organized and oversaw this cross-sectional study. The practical portion was carried out on 90 patients with NSTE-ACS based on European society of cardiology (ESC) guidelines (and they agreed for invasive strategy) between May 2019 and December 2020 at Salalah Heart Center in Sultanate of Oman. All patients underwent a full clinical examination, 12-lead ECG, and serial high-sensitivity troponin T (hs-TnT) in addition to a thorough history taking process. On patient's admission, the GRACE risk score was assessed. All patients who were suspected of having NSTE-ACS upon admission underwent transthoracic echocardiography, including two-dimensional speckle tracking (2D-ST). Left ventricular global longitudinal strain (LV-GLS %) was measured and analyzed using 2D speckle tracking. SYNTAX Score was determined for all patients.
Results:
By analysis of the performance of LV-GLS% in prediction of high risk by GRACE score, we found that with cutoff (≥-13.8), the AUC was (0.944) with sensitivity, specificity, PPV, NPV, and accuracy (0.944, 93.3%, 84%, 53.8%, 98.4%, 85.6%), respectively.
Conclusion:
Global longitudinal strain can predict accurately high-risk NSTE-ACS patients by GRACE score.
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