Resting Tissue Doppler Imaging for Detecting Coronary Artery Disease in Patients with Preserved Ejection Fraction and No Wall Motion Abnormalities

Background and Objectives: Coronary artery disease may be difficult to detect by resting echocardiography when left ventricular ejection fraction is preserved and regional wall motion abnormalities are absent. This study aimed to assess whether resting Tissue Doppler Imaging-derived mitral annular velocities can help identify CAD in patients with suspected angina pectoris. Materials and Methods: We conducted a cross-sectional observational study of 92 patients hospitalized with suspected angina pectoris who underwent elective coronary angiography at the Institute of Cardiovascular Diseases in Timișoara (January 2025–February 2026). Patients with conditions known to affect TDI-derived parameters were excluded, including previous acute coronary syndrome or myocardial revascularization, significant valvular disease, cardiomyopathies, relevant arrhythmias or conduction abnormalities, permanent pacing, reduced ejection fraction, and pericardial disease. Laboratory and echocardiographic data were collected. ROC curve analysis, univariable logistic regression and multivariable logistic regression were performed to evaluate the diagnostic performance of TDI-derived parameters and their independent association with coronary artery disease. Results: Patients with CAD had significantly lower average E′ values (7.4 ± 1.9 vs. 8.9 ± 1.8 cm/s, p < 0.001) and average S′ values [7.0 (IQR 6.0–7.5) vs. 9.0 (IQR 8.1–10.0) cm/s, p < 0.001], together with higher E/E′ ratios [9.33 (IQR 8.23–11.15) vs. 7.87 (IQR 5.93–9.51), p = 0.002]. Average S′ showed the highest discriminative ability for coronary artery disease, with an AUC of 0.899 (95% CI: 0.819–0.952, p < 0.0001). The optimal Youden-derived cut-off was ≤7.5 cm/s, yielding 77.42% sensitivity and 93.33% specificity. After adjustment for age, male sex, body mass index, diabetes, smoking status, hypertension and LVEF, dichotomized S′ remained an independent predictor of coronary artery disease (OR = 45.49, 95% CI: 8.03–257.68, p < 0.0001), with an adjusted model AUC of 0.92 and 88.04% correct classification. Conclusions: TDI, particularly S′ velocity, may be a useful resting echocardiographic parameter for identifying CAD in selected patients with preserved LVEF and no resting regional wall motion abnormalities. Rather than serving as a universal diagnostic marker, S′ should be considered a complementary, easily obtainable parameter that may improve non-invasive assessment in this specific clinical setting.