Predictors of Coronary Artery Disease in Patients With ST ‐T Segment Alterations Undergoing Elective Coronary Angiography: The Role of Global Longitudinal Strain

Objective Electrocardiography (ECG) is recommended as first investigation for chronic coronary artery disease (CAD), often showing ST segment depression and/or T‐wave changes, which are nonspecific. We aimed to identify predictors of CAD presence and severity in patients with ST‐T changes undergoing elective coronary angiography (ECA). Methods In this prospective cross‐sectional study, 84 consecutive patients with ST‐T changes on ECG undergoing ECA were evaluated using clinical, electrocardiographic, conventional echocardiography, and speckle tracking parameters. Multivariable logistic and linear regression analyses were performed to identify independent factors associated with CAD presence and severity. Results Of the 84 patients, 36 (42.9%) had significant CAD. The number of affected vessels was significantly associated with age, male sex, smoking, typical chest pain, WMSI, and LVGLS (all p ≤ 0.01). In multivariable logistic regression, male sex (OR 2.89, 95% CI 1.36–6.11, p = 0.006), typical chest pain (OR 2.26, 95% CI 1.05–4.87, p = 0.04), and LVGLS (OR 2.11, 95% CI 1.41–3.13, p < 0.001) were independently associated with CAD. In multivariable linear regression, LVGLS (std β = 0.32, p = 0.001), sex (std β = 0.29, p < 0.001), smoking (std β = 0.22, p = 0.003), and WMSI (std β = 0.20, p = 0.039) were independently associated with the number of affected coronary vessels. LVGLS demonstrated excellent diagnostic performance (AUC = 0.89, 95% CI 0.82–0.97, p < 0.001). Conclusions In patients with ST‐T changes, LVGLS, male sex, and typical chest pain independently predict the presence of CAD, while LVGLS is also strongly associated with disease severity. LVGLS shows excellent discriminatory ability and may improve noninvasive risk stratification in this population.