Key result
Segmental early diastolic strain rate deviation accurately detects severe CAD requiring CABG with ~0.93 AUC.
Why the study?
Myocardial strain curves provide insights beyond peak strain measurements, but the diagnostic utility of time-aligned segmental strain and strain rate curves for obstructive CAD in chest pain patients needed evaluation.
Does time-aligned segmental strain and strain rate analysis improve the diagnostic detection of obstructive coronary artery disease in patients with chronic chest pain?
Observational (n=510)
No
Does time-aligned segmental strain and strain rate analysis improve the diagnostic detection of obstructive coronary artery disease in patients with chronic chest pain?
Effect estimate: AUC 0.933 (95% CI 0.900-0.967)
p-value: p=< 0.0001
Resting time-aligned segmental strain analysis accurately identifies severe coronary artery disease requiring CABG, but lacks the sensitivity to reliably detect milder forms of the disease like single-vessel disease.
May identify severe CAD needing CABG in chronic chest pain; leaves open prospective validation before clinical adoption.
Background Myocardial strain curves provide valuable insights into coronary artery disease (CAD) beyond conventional peak strain measurements. This study aimed to evaluate the diagnostic utility of time-aligned segmental strain and strain rate (S/SR) curves to identify obstructive CAD in consecutive chest pain patients. Methods A total of 510 chest-pain patients referred to coronary computed tomography angiography (CCTA) were included. Segmental strain curves were time-aligned using aortic valve closure (AVC) and cardiac cycle length as reference points. Average S/SR curves were generated for 18 myocardial segments, establishing reference curves from a group of 314 chronic chest-pain patients without CAD (No-CAD). Deviations were defined based on thresholds of peak S/SR or average S/SR curve deviation over systole and the first half of diastole. Results Significant differences were observed between groups, particularly between the revascularized MI, CABG, or 3-vessel CAD groups compared to the No-CAD group (p<0.05). ROC curve analysis demonstrated excellent diagnostic performance for CABG patients (AUC up to 0.933), while the detection rate for PCI was limited (AUC < 0.7). Global longitudinal strain rate in early diastole (GLSR E) and segmental peak SR E showed the highest diagnostic accuracy. These findings confirm that time-aligned strain analysis improves the detection of significant CAD but remains limited for identifying patients with mild disease. Conclusion Time-aligned segmental strain analysis improved detection of high-grade disease requiring CABG but could not distinguish single-vessel from non-obstructive CAD. Pathological strain patterns became significant only in advanced CAD, indicating that segmental resting strain analysis has clinical utility primarily for identifying advanced CAD.
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Rösner et al. (2026) conducted an observational in Chronic chest pain with suspected obstructive coronary artery disease (n=510). Time-aligned segmental strain and early diastolic strain rate (GLSR E) imaging vs. No coronary artery disease or non-obstructive coronary artery disease was evaluated on Diagnostic performance (AUC) for detecting advanced coronary artery disease requiring CABG (AUC 0.933, 95% CI 0.900-0.967, p=< 0.0001). Time-aligned segmental early diastolic strain rate deviation demonstrated excellent diagnostic performance for detecting severe coronary artery disease requiring CABG, with an AUC of 0.933.
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