Correlation between Myocardial Strain Imaging by Two-dimensional Speckle Tracking and Coronary Angiographic Profile in Patients with Chronic Coronary Syndrome

Background: Chronic coronary syndrome (CCS) constitutes 20%–30% of cardiac causes of chest pain. Deformation/Strain imaging is a sensitive marker of coronary artery disease (CAD) which detects subtle forms of ischemia in the form of strain. We aim to correlate global longitudinal and segmental strain with angiographic profile by using two-dimensional speckle tracking echocardiography (2D-STE). Materials and Methods: A prospective observational study was carried out on 150 subjects satisfying the inclusion criteria. Routine blood investigations, electrocardiogram, 2D echocardiography, and 2D-STE were performed. All subjects underwent coronary angiogram (CAG), and the severity of CAD was assessed by modified Gensini score (mGS). Global longitudinal strain (GLS) and segmental strain were correlated with mGS. Results: Mean age was 55.28 ± 8.94 years. Males constituted 67.3% of the study population. The most common symptom was angina (54%), and the most common risk factor was type 2 diabetes mellitus (37%). Mean left ventricular ejection fraction (LVEF) was 58.6%. The mean GLS in the Significant CAD group was −13.8% and in the Insignificant CAD group was −17.7% ( P < 0.01). The Pearson correlation analysis between GLS and segmental strain had a strong negative correlation ( P < 0.01). GLS cutoff for significant single vessel disease was −18.8 (sensitivity 98%, specificity 86%, area under the curve 0.93; P = 0.03). Conclusion: This study emphasizes the role of a simple, noninvasive transthoracic echocardiographic marker in predicting subclinical ischemia in CCS who have apparently normal LVEF. GLS correlates with the angiographic severity in CCS. The myocardial segmental strain correlates with angiographic territorial involvement. It is an independent predictor of significant CAD with good sensitivity and specificity.