Key result
LV global longitudinal strain and Agatston score show high diagnostic accuracy for significant coronary stenosis.
Why the study?
Initial pretest probability assessment of CHD lacks high sensitivity and specificity, making it important to determine the diagnostic value of supplementary methods like the Agatston score and left ventricular GLSavg in patients with a low pretest probability.
Does evaluation with the Agatston score and left ventricular Global Longitudinal Strain average accurately identify hemodynamically significant coronary artery stenosis in patients with a low pre-test probability of coronary heart disease (5-15%)?
Cross-Sectional (n=95)
Does evaluation with the Agatston score and left ventricular Global Longitudinal Strain average accurately identify hemodynamically significant coronary artery stenosis in patients with a low pre-test probability of coronary heart disease (5-15%)?
Both the Agatston score (cut-off 120 units) and left ventricular GLSavg (cut-off -18%) demonstrate high diagnostic sensitivity for identifying hemodynamically significant coronary stenosis in patients with a low pre-test probability of CHD, helping to clarify indications for invasive coronary angiography.
May support noninvasive stenosis evaluation in low-probability patients; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Coronary heart disease (CHD) is the leading cause of mortality among diseases of the circulatory system. Early identification of CHD facilitates timely diagnosis and reduces mortality. The initial assessment during a physician's visit is the pretest probability (PTP) of CHD, which lacks high sensitivity and specificity. Therefore, determining the prognostic value of additional, clarifying examination methods is important. AIM: To evaluate the diagnostic sensitivity and specificity of the Agatston score and left ventricular Global Longitudinal Strain average (GLSavg) for identifying hemodynamically significant coronary artery stenosis in patients with PTP of CHD between 5% and 15%. METHODS: A cross-sectional cohort study of patients (n=95) of both sexes (more than 57% to men and more than 42% to women) aged 45–65 years, meeting inclusion criteria (signed informed consent for participation in the study and a PTP value of 5–15%) was conducted in 2024–2025. RESULTS: The main comorbidities were arterial hypertension and/or dyslipidemia. The Agatston score was 344 [95; 652] units, GLSavg was -18 [-20;-15]%. Hemodynamically significant coronary artery stenosis was detected in 50.5% of cases. The cut-off point for the Agatston score was 120 units; diagnostic sensitivity: 96.55%, specificity: 55.56%; area under the ROC curve: 0.746±0.072 (95% confidence interval 0.612–0.853, z=3.421, p=0.0061). The cut-off point for GLSavg was -18%; diagnostic sensitivity: 93.10%, specificity: 77.78%; area under the ROC curve: 0.945±0.026 (95% confidence interval 0.849–0.988, z=16.769, p=0.00012). CONCLUSION: Based on the study results, the cut-off values for the Agatston score and GLSavg, as well as their sensitivity and specificity, were determined. Despite certain limitations of the study (sample size), these values allow for clarifying the indications for coronary angiography.
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Shlyk et al. (2026) conducted a cross-sectional in Suspected coronary heart disease (pretest probability 5-15%) (n=95). Agatston score and left ventricular Global Longitudinal Strain average (GLSavg) vs. Coronary angiography was evaluated on Hemodynamically significant coronary artery stenosis (AUC 0.945 (GLSavg); AUC 0.746 (Agatston score), 95% CI 0.849-0.988, p=0.00012). Agatston score (AUC 0.746, p=0.0061) and LV GLSavg (AUC 0.945, p=0.00012) showed high diagnostic value for detecting significant coronary stenosis in low pretest probability patients.
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