Role of Speckle Tracking Echocardiography in Assessing Anginal Chest Pain on Exertion

Background: Left bundle branch block (LBBB) poses some restriction on coronary artery disease (CAD) diagnosis with noninvasive diagnostic modalities. Objectives: Evaluating the role of 2-D speckle tracking echocardiography (STE) in the diagnosis of CAD in patients with LBBB. Patients and Methods: This was asingle-center observational prospective study that lasted for 3 years. 80 patients with LBBB complaining of exertional chest pain underwent STE and coronary angiography (CA). Results: 50 patients were put in group I, on exclusion of significant CAD. Group II had 30 patients having significant CAD on CA. Global longitudinal strain (GLS) of the left ventricle was higher in group II patients (p value of 0.0001). Also, time to peak strain in apical 2 chamber view (TTPS AP2), apical 3 chamber view (TTPS AP3) and apical 4 chamber view (TTPS AP4) were significantly higher among group II patients (p-value of 0.0001, 0.0001 and 0.0001 respectively). GLS can predict significant CAD using cutoff point of 11.4%, with sensitivity of 66% and specificity of 90% (p-value 0.0001). TTPS AP2 can predict significant CAD using cutoff point of 399.5 milliseconds (ms), with a sensitivity of 90% and specificity of 58% (p value 0.0001). TTPS AP3 can predict significant CAD using cutoff point of 385.5 ms, with a sensitivity of 73.3% and specificity of 72% (p-value of 0.0001). TTPS AP4 can predict significant CAD using cutoff point of 377.5 ms, with sensitivity of 90% and specificity of 52% (p-value of 0.0001). Conclusion: STE could be valuable in the assessment of LBBB patient with suspected CAD.