Association between global longitudinal strain and coronary artery calcium in the diagnosis of significant coronary artery disease

Abstract Introduction Non-invasive diagnostic methods for coronary artery disease (CAD) are gaining increasing importance due to their accessibility, diagnostic value, safety, and cost-effectiveness. Both global longitudinal strain (GLS) and coronary artery calcium (CAC) scores have demonstrated high diagnostic utility. However, the combined use of these modalities remains insufficiently studied. Objective To evaluate the diagnostic effectiveness of GLS and CAC in detecting significant CAD and to determine whether their combined application provides superior diagnostic value compared to each method used independently. Materials and Methods This prospective cross-sectional study included 163 patients referred to our clinic for invasive coronary angiography to assess suspected CAD. All patients additionally underwent transthoracic echocardiography with GLS measurement, and non-contrast cardiac computed tomography with CAC scoring using the Agatston method. Exclusion criteria included acute coronary syndrome, heart failure (left ventricular ejection fraction 55%), regional wall motion abnormalities on echocardiography, a history of CAD, or significant valvular heart disease. Results The study population consisted of 163 patients with a mean age of 57.09 ± 9.9 years. A history of arterial hypertension was present in 87.7% of cases, hypercholesterolemia in 78%, diabetes mellitus in 28.8%, and smoking in 30.06%. CAD was diagnosed in 102 patients (62%), of whom 64 (39%) had significant CAD (defined as ≥70% stenosis), while the remaining 99 (60.7%) had either non-significant CAD or normal coronary arteries. Patients with significant CAD had lower GLS values compared to those with non-significant CAD (–14.9 ± 3.5% vs. –16.3 ± 1.6%, p = 0.006). Additionally, CAC scores were significantly higher in patients with significant CAD compared to those without (446.9 ± 283.7 vs. 34.7 ± 101.1, p 0.0001). Conclusions The combined model demonstrated superior diagnostic accuracy compared to each parameter alone (AUC for GLS = 0.87, CAC = 0.89, and combined GLS + CAC = 0.93), as shown in table 1. These findings support the integrated use of GLS and CAC scoring as a more effective non-invasive strategy for identifying patients with significant coronary artery disease.Table 1