Left ventricular regional longitudinal strain assessed during speckle-tracking stress echocardiography with physical exercise may identify severe coronary artery disease
Authors: Stepanova A , Radova NF , Alekhin MN 
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Assessment of global longitudinal strain of the left ventricular (LV) myocardium during stress echocardiography showed promising results in diagnosing transient myocardial ischemia. Regional longitudinal strain (RLS) allows to evaluate LV systolic function more precisely. However, due to the heterogeneity of LV segments contraction, an isolated assessment of LV RLS values can be challenging. We suggest that evaluation of the mean LV RLS values for the basal, middle and apical regions of the LV during stress echocardiography may be more useful in clinical setting.

Aim of the study. The aim of the study was to determine the diagnostic capabilities of the LV RLS assessed during stress echocardiography with exercise on the treadmill in defining the presence and significance of coronary artery disease (CAD).

Methods. The study included 132 patients (65.0 ± 9.3 years, 85 men) with known or suspected CAD. All patients underwent speckle-tracking stress echocardiography with exercise on the treadmill. At rest and after treadmill test all patients were measured for the values of LV RLS using the AFI (Automated functional imaging) algorithm. The LV RLS values for basal, middle and apical regions were calculated as the ratio of the sum of LV RLS values of the segments of each region to the number of segments. Segments of the LV were represented with the standard 17-segment model of the LV, 1-6 segments were assigned as basal segments; 7-12 segments as middle segments and 13-17 as apical segments (Picture 1). All patients underwent coronary angiography; the severity of CAD was assessed using the Gensini score. According to the results of coronary angiography, patients were divided into 3 groups: group 1 – 42 patients without CAD, group 2 – 63 patients with moderate CAD (&lt;34 points on the Gensini score) and group 3 – 27 patients with severe CAD (≥ 35 points on the Gensini score).

Results. At rest LV RLS values in basal, middle and apical regions did not significantly differ between the groups. Picture 2 shows that after the load, LV RLS values in basal, middle and apical regions in patients with severe CAD were significantly lower than in groups of patients without CAD and with moderate CAD. The values of LV RLS in patients with severe CAD decreased in all regions after the load, while in patients without CAD and with moderate CAD, LV RLS values increased in middle and apical regions and decreased in basal region.

Conclusion. In patients with severe CAD (≥ 35 points on the Gensini score) after the load on the treadmill LV RLS values in all regions were significantly lower than in patients without CAD and with moderate CAD. Thus, LV RLS assessed during speckle-tracking stress echocardiography on the treadmill may be useful in identifying patients with severe CAD. Abstract Figure. Picture 1. 17-segment model of the LV  Abstract Figure. Picture 2. Results of stress test