Global longitudinal strain ≤ -17.25% diagnosed high-risk coronary artery disease with 80.7% sensitivity and 93.2% specificity, outperforming treadmill test.
Does global longitudinal strain echocardiography improve diagnostic accuracy for high-risk coronary artery disease in patients with chronic stable angina and a positive treadmill test?
Resting global longitudinal strain echocardiography provides high specificity and diagnostic accuracy for identifying high-risk coronary artery disease in patients with stable angina, improving upon standard treadmill testing.
Objective The study aims to determine the importance of global longitudinal strain echocardiography in diagnosing high-risk coronary artery disease in patients with chronic stable angina. Methods This study was a prospective observational study with a sample size of 101 patients aged above 18 years presenting with chronic stable angina to our hospital who were treadmill test positive. All the patients underwent two-dimensional speckle tracking echocardiography for measuring global longitudinal strain and an invasive coronary angiography. Treadmill test and global longitudinal strain were compared to see the sensitivity and specificity of both tests for diagnosing high-risk coronary artery disease. Receiver operating characteristic curve analysis was used to identify the ideal cutoff of global longitudinal strain for diagnosing high-risk coronary artery disease. Results In the total of 101 participants, global longitudinal strain was reduced significantly in participants with high-risk coronary artery disease than those without coronary artery disease 18.43 ± 1.97 vs. 15.78 ± 1.46, P < .001. For treadmill test with Duke treadmill score cutoff as −3, it has a sensitivity of 78.9% and a specificity of 63.6% as compared to global longitudinal strain, which has a sensitivity of 71.9% and a specificity of 97.7%. Receiver operating characteristic curve analysis showed that the optimal cutoff for the identification of coronary artery disease for global longitudinal strain was −17.25% (sensitivity of 80.7% and specificity of 93.2%), confidence interval 0.76-0.89, area under curve = 0.895, P < .001. Conclusion The present study showed that resting global longitudinal strain is significantly reduced in patients with high-risk coronary artery disease, hence, when done in addition to stress testing in patients with chronic stable angina, it improves accuracy in diagnosing high-risk coronary artery disease.
Nadkarni et al. (2026) studied this question. Global longitudinal strain ≤ -17.25% diagnosed high-risk coronary artery disease with 80.7% sensitivity and 93.2% specificity, outperforming treadmill test.