Key result
Baseline LV global longitudinal strain < -16% prior to stress echocardiography had a 98.5% negative predictive value for detecting myocardial ischemia (1.5% vs 9.8% positive tests, P=0.038).
Why the study?
It was not known whether changes in baseline LV strain can predict myocardial ischemia.
Does baseline LV GLS < -16% predict the absence of myocardial ischemia on stress echocardiography in moderate-risk patients evaluated for CAD?
Observational (n=118)
No
Does baseline LV GLS < -16% predict the absence of myocardial ischemia on stress echocardiography in moderate-risk patients evaluated for CAD?
Baseline LV GLS < -16% has a high negative predictive value (98.5%) for myocardial ischemia on stress echocardiography, suggesting it could be a cost-effective triage tool.
May support GLS triage to reduce unnecessary stress testing in moderate-risk CAD; leaves open prospective validation before practice change.
Background: Left ventricular (LV) strain in echocardiography has been utilized as a determinant of myocardial function and a predictor of LV dysfunction prior to a reduction in ejection fraction. However, it is not known if changes in baseline LV strain can predict ischemia. Methods : This single center retrospective study at the University of Cincinnati aimed to evaluate the predictive value of baseline LV global longitudinal strain (GLS) obtained prior to stress echocardiogram (sEcho) for detecting myocardial ischemia in moderate risk patients undergoing evaluation for coronary artery disease (CAD). The study included 118 patients who underwent sEcho for CAD evaluation. Baseline LV GLS was measured in the apical 4 chamber, apical 2 chamber, and parasternal long axis views using Phillips or General Electric machines. Patients were divided into two groups based on pre-stress GLS values: GLS < -16% (n=67, 56.8%) and GLS ≥ -16% (n=51, 43.2%). Results: The mean age of the patients was 53.6±12.1 years, 55.9% were women, and 31.4% belonged to a non-white racial or ethnic group. The average baseline GLS values were -19.1%±2.4 and -13.5%±2.0 for patients in the GLS < -16% and GLS ≥ -16% baseline strain groups, respectively. Overall, 5.1% of the study population had a positive sEcho. Only one patient with GLS < -16% had a positive sEcho (P=0.038). The negative predictive value of GLS < -16% for a positive stress test was 98.5%. Conclusions: Assessing baseline LV GLS prior to sEcho could be a cost-effective and efficient predictor of stress outcomes in moderate-risk patients undergoing evaluation for CAD. Our results suggest that a baseline GLS value < -16% has a high negative predictive value for myocardial ischemia detected by sEcho. However, larger studies in more diverse populations are needed to confirm these findings.
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Biondi et al. (2023) conducted an observational in Coronary artery disease (n=118). Baseline LV global longitudinal strain (GLS) < -16% vs. Baseline LV GLS ≥ -16% was evaluated on Positive stress echocardiogram (p=0.038). Baseline LV global longitudinal strain < -16% prior to stress echocardiography had a 98.5% negative predictive value for detecting myocardial ischemia (1.5% vs 9.8% positive tests, P=0.038).
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