Comparison of Application Value of Global Longitudinal Strain and Myocardial Work in Predicting Severe Coronary Artery Stenosis by Echocardiography

Background: Conventional echocardiography identifies STEMI by regional wall motion abnormality (RWMA), but it still has a great challenge to identify other types of coronary artery disease (CHD). The Two-dimensional Speckle Tracking Echocardiography (2D-STE) makes up for some of the deficiency, especially by using the myocardial work which combined with the left ventricular pressure condition. By this way, the dysfunctional region of myocardium can be identified more accurately, which is expected to be a new non-invasive prediction method for CHD. Methods: According to the exclusion criteria, 140 patients who had received coronary angiography (CAG) were included in this study. According to the stenosis rate of coronary artery, the patients were divided into CHD group and control group. The predictive efficacy of GLS and GWI for severe coronary artery stenosis were compared by ROC curve. Then, the 140 patients were respectively re-grouped according to the stenosis rate of LAD, LCX and RCA three times. The regional GLS and GWI are recorded as GLS R and GWI R according to the PRI method described in this article. The efficacy of GLS R and GWI R in predicting severe coronary artery stenosis were compared. Certainly the prediction efficiency between PRI method and traditional method (using the value of GLS and GWI directly) were also compared. Results: In predicting severe coronary artery stenosis, compared with GLS R , GWI R showed significantly higher sensitivity (95.2% vs 70.2%) and similar specificity (87.5% vs 91.1%). In the aspect of identification of certain coronary artery with severe stenosis, the sensitivity of GWI R was significantly higher than GLS R in predicting severe stenosis of LAD, LCX, and RCA (LAD: 96.5% vs 64.9%; LCX: 65.6% vs 50.0%; RCA: 50% vs 20%). Compared with traditional method, the “positive region identification” method has higher AUC in the ROC curve. Conclusion: GWI is more sensitive than GLS in identifying patients with CHD that couldn’t be detected by conventional echocardiography and performs better in accurately disclosing the culprit coronary arteries with severe stenosis. Compared with the traditional method, the PRI method can be used to judge whether there is severe stenosis in any coronary artery more accurately and confidently.