Time-aligned segmental strain as a diagnostic marker for obstructive coronary artery disease in patients with chronic chest pain

Abstract Background Myocardial strain curves provide valuable insights into coronary artery disease (CAD) beyond conventional peak strain measurements. This study aimed to evaluate the diagnostic utility of time-aligned segmental strain and strain rate (S/SR) curves to identify obstructive CAD in chest pain patients undergoing coronary computed tomography angiography (CCTA). Methods A total of 510 chest pain patients referred for CCTA and 88 post-revascularized MI patients were included. Transthoracic echocardiography (TTE) was performed, and segmental strain curves were time-aligned using aortic valve closure (AVC) and cardiac cycle length as reference points. Average S/SR curves were generated for 18 myocardial segments, establishing reference curves from a group of 314 chronic chest-pain patients without CAD. Deviations were defined based on thresholds of peak S/SR or average S/SR curve deviation over systole and the first half of diastole. Results Significant differences were observed between groups, particularly between the revascularized MI, CABG, or 3-vessel CAD groups compared to the No-CAD group (p