Two-Dimensional Speckle Tracking Echocardiography - a Useful Non-Invasive Method in Predicting Significant Coronary Artery Disease in Low Risk Acute Coronary Syndrome.

Objectives: To evaluate if global and regional longitudinal strain (LS) using two-dimensional speckle tracking echocardiography (2DSTE) could be useful to predict significant coronary artery disease (CAD) in patients with low risk acute coronary syndrome (ACS). We also assessed if LS is compensatory augmented in nonischemic segments and whether the gradient of LS between segments (LSD) would be higher in this category of patients. Methods: 117 consecutive patients presenting with low risk ACS, without wall motion abnormalities on conventional echocardiography underwent LS analysis by 2DSTE and coronary angiography. Global peak systolic longitudinal strain (GLS) of the 18 segments of left ventricle (LV), GLS of 12 segments of LV, LSD and longitudinal strain ratio (LSR), defined as the ratio of LSD to GLS were calculated. Territorial correlation between the segmental LS and angiography was also assessed. Results: GLS18 and GLS12 were significantly decreased, while LSD and LSR were increased in patients with CAD comparative with those without CAD. Moreover GLS18, GLS12, LSD and LSR had moderate predictive value for CAD (AUC 0.631, 0.67, 0.617 and 0.665 respectively). The regional predefined LS had moderate predictive value for left anterior descending artery disease (AUC=0.718) and right coronary artery disease (AUC=0.627), but not for circumflex disease (AUC=0,555). Conclusions: In low-risk ACS, global and regional LS could be a powerful noninvasive diagnostic tool for significant CAD. LSD and LSR are also valuable parameters, and together with standard strain parameters could improve the accuracy of rest echocardiography in the diagnosis of CAD. [ABSTRACT FROM AUTHOR]