Incremental value of early systolic lengthening and postsystolic shortening in detecting left anterior descending artery stenosis using nonstress speckle-tracking echocardiography

Figures

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  Figure 1. Representative strain–time curves in six segments (left) and the apical anterior segment (right) of the apical 2-chamber view. (a) An 83-year-old female with 29% diameter stenosis of the left anterior descending artery (LAD) derived from quantitative coronary angiography. (b) A 67-year-old male with 58% LAD stenosis. (c) A 56-year-old male with 88% LAD stenosis. The absolute value of the peak systolic strain (red circle) decreased, and early systolic lengthening (ESL) and postsystolic shortening (PSS) became larger with the severity of LAD stenosis, resulting in prolonged TESL (white arrow) and TPSS (yellow arrow).

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  Figure 2. Peak systolic strain, TESL, and TPSS in the three groups. In the single-vessel group, the absolute value of the peak systolic strain was significantly lower, and TESL and TPSS were significantly longer than those of the no stenosis group. In the multivessel group, the peak systolic strain was also significantly lower. TESL and TPSS tended to be prolonged but not to a statistically significant degree. *P < 0.05 versus the no stenosis group. †P < 0.01 versus the no stenosis group.

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  Figure 3. Incremental value of TESL and TPSS by multivariable logistic regression models. (a) In the single-vessel group, the peak systolic strain was a significant parameter in diagnosing left anterior descending artery (LAD) stenosis, and TESL and TPSS were also independent determinants in the logistic regression analysis. The addition of TESL and TPSS to the peak systolic strain significantly increased the model power. (b) In the multivessel group, the peak systolic strain was also a significant parameter in diagnosing LAD stenosis. However, the addition of TESL and TPSS did not generate a significant increase in the model power. The tables present the odds ratios and 95% confidence intervals.

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  Figure 4. Receiver operating characteristic curve analysis for diagnosing left anterior descending artery (LAD) stenosis. (a) Compared with the peak systolic strain alone, the integrated analysis of the three parameters from using the regression function significantly improved the accuracy in diagnosing single-vessel LAD stenosis (P = 0.040). (b) The integrated analysis did not improve the accuracy in diagnosing multivessel LAD stenosis (P = 0.832).