Territorial longitudinal strain to predict the location and severity of significant stenosis in stable coronary artery disease

Introduction and objectives:There is limited data on territorial longitudinal strain (TLS) as an echocardiographic marker in stable coronary artery disease (CAD).We evaluated the predictive role of TLS in stable CAD for identifying the location and severity of significant coronary artery stenosis.Methods: We included patients presenting with chest pain, whereas those with myocardial infarction, arrhythmia, normal coronary angiography, previous percutaneous coronary intervention or coronary artery bypass grafting, and inadequate echocardiographic window were excluded.Among the 738 patients enrolled, a total of 199 study participants with stable CAD were selected and underwent speckle tracking echocardiography.Results: Regional longitudinal strain (RLS) identified significant stenosis in at least 1 of the coronary arteries with sensitivity and specificity rates of 89.4% and 87.8%, respectively, and an area under curve (AUC) of 0.947 (P < .001).Receiver operating characteristic curve comparison demonstrated RLS had the highest predictive value for identifying significant stenosis with an optimal cutoff of ≥ -16% compared with regional radial strain (RRS) (AUC difference, 0.149; 95%CI, 0.132-0.167;P ≤ .0001),regional wall motion abnormality (RWMA) (AUC difference, 0.277; 95%CI, 0.262-0.293;P ≤ .0001),and regional circumferential strain (RCS) (AUC difference, 0.348; 95%CI, 0.327-0.368;P ≤ .0001).TLS predicted significant proximal left anterior descending coronary artery stenosis when ≥ 4 of 7 territorial segments were impaired, significant proximal left circumflex artery stenosis when ≥ 3 of 5 territorial segments were impaired, and significant proximal right coronary artery stenosis when ≥ 3 of 5 territorial segments were impaired.Conclusions: TLS predicted the location and severity of significant coronary artery stenosis in patients with stable CAD.[Trial registration No. Md 110/2021].