Can Resting Segmental Strain Identify Obstructive Coronary Artery Disease in Chronic Coronary Syndrome Patients
Assami Rösner1,2, Didrik Kjønås1,3, Marie Leiros Sandberg2
1Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway.
Insights
Resting segmental strain imaging, using tissue Doppler or speckle tracking, effectively identifies obstructive coronary artery disease (CAD) in patients referred for bypass surgery. Tissue Doppler strain demonstrated high accuracy, even with preserved heart function and no myocardial scarring.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Noninvasive identification of chronic coronary syndrome (CCS) with obstructive coronary artery disease (CAD) is challenging.
- Strain imaging detects subtle myocardial dysfunction, potentially marking multivessel or left main CAD.
- This study evaluated resting segmental systolic strain for identifying obstructive CAD in patients referred for coronary artery bypass grafting (CABG).
Purpose of the Study:
- To assess resting segmental systolic strain's ability to identify obstructive CAD in CABG-referred patients.
- To compare the diagnostic performance of tissue Doppler imaging (TDI) strain versus 2D speckle-tracking echocardiography (STE).
- To evaluate strain imaging's effectiveness in detecting subclinical dysfunction, even with preserved ejection fraction and no myocardial scarring.
Main Methods:
- Retrospective analysis of 61 CCS patients with obstructive CAD referred for CABG and 61 matched controls.
- Echocardiography with both TDI and STE strain analysis was performed.
- Late gadolinium enhancement (LGE) cardiac MRI assessed myocardial scarring; diagnostic performance was evaluated using receiver operating characteristic analysis (AUC).
Main Results:
- Tissue Doppler strain showed excellent diagnostic accuracy (AUC 0.95) for identifying myocardial dysfunction in CABG-referred patients at a -8% threshold.
- TDI strain performed comparably or better than STE strain (AUC 0.79).
- TDI strain identified obstructive CAD with 95% sensitivity and 86% specificity, effective even in patients without LGE-defined scars.
Conclusions:
- Resting segmental strain imaging by TDI and STE can detect subclinical regional dysfunction in CABG-referred patients with obstructive CAD.
- TDI strain demonstrated at least equal diagnostic accuracy to STE strain.
- Resting segmental strain analysis is a sensitive, noninvasive tool for identifying obstructive CAD in this population.
Introduction:
Noninvasive identification of patients with chronic coronary syndrome (CCS) with obstructive coronary artery disease (CAD) remains a clinical challenge. Strain imaging enables detection of subtle myocardial dysfunction at rest and may serve as a sensitive marker of multivessel or left main CAD. This study aimed to assess whether segmental systolic strain at rest can identify patients with obstructive CAD referred for coronary artery bypass grafting (CABG) and to compare diagnostic performance of tissue Doppler imaging strain with two-dimensional speckle-tracking echocardiography in a retrospective analysis of a selected CABG-referred cohort.
Methods:
This retrospective study included 61 patients with CCS and obstructive CAD referred for CABG and 61 age- and sex-matched healthy controls from the population-based Nord-Trøndelag Health Study. All participants underwent echocardiography with both tissue Doppler and speckle-tracking strain analysis. The number of hypokinetic segments within one heart was counted, determined at different segmental peak longitudinal strain thresholds of -8% to -16%. The area under curve (AUC) using receiver operating characteristic analysis was used to evaluate diagnostic performance. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (MRI) was used to assess myocardial scarring.
Results:
LGE MRI confirmed that 78% of patients had no visible myocardial scar and that overall scar burden was low (2.8%). At a hypokinetic strain threshold of -8%, tissue Doppler strain demonstrated excellent diagnostic accuracy for identifying myocardial dysfunction in CABG-referred patients (AUC 0.95, 95% confidence interval [CI]: 0.91-1.00), performing at least as well as speckle-tracking strain (AUC: 0.79, 95% CI: 0.70-0.87). Tissue Doppler strain identified obstructive CAD with 95% sensitivity and 86% specificity. Comparable AUCs were found in a subgroup of 20 patients without coronary occlusion or myocardial scarring, indicating that regional hypokinesia was equally detectable in patients with normal EF and no LGE-defined scars.
Conclusion:
Segmental strain imaging at rest - by both tissue Doppler and speckle tracking - can detect subclinical regional dysfunction in CABG-referred patients with obstructive CAD, even in patients with preserved global left ventricular function and no evidence of myocardial scarring. Tissue Doppler strain showed at least as high diagnostic accuracy as speckle-tracking strain. These findings underscore the clinical potential of resting segmental strain analysis as a sensitive, noninvasive tool for identifying obstructive CAD in this selected CABG-referred population.
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