Additional diagnostic accuracy of global longitudinal strain at peak dobutamine stress in patients with moderate pretest probability of coronary artery disease.

Elamragy, Ahmed A; Abdelwahab, Mohamed A; Elremisy, Dalia R; Hassan, Mohamed; Ammar, Waleed A; Taha, Hesham S

BACKGROUND Previous studies confirmed the feasibility of 2D speckle tracking echocardiography (2D STE) during dobutamine stress echocardiography (DSE) in assessing myocardial ischemia in patients with previous myocardial infarction. It is unknown whether it improves the diagnostic accuracy in young patients with intermediate pretest probability for coronary artery disease (CAD) and no prior cardiovascular events. METHODS We prospectively studied 101 patients by DSE and STE, followed by coronary angiography within 1 month. Significant CAD was defined as diameter stenosis ≥ 50%. Receiver operating characteristic analysis obtained global longitudinal strain (GLS) cutoff values of significant area under the curve (AUC). RESULTS Mean age: 53 ± 8 years, 56% females, 49 had significant CAD (group 1) and 52 had normal/mild CAD (group 2); no significant baseline differences except more males in group 1 (P: .002). DSE sensitivity and specificity for CAD were 79.6% and 92.3%, respectively, positive predictive value (PPV): 90.6%, negative predictive value (NPV): 82.7%, and diagnostic accuracy: 86%. At peak stress, all strain parameters were significantly lower in group 1. However, GLS had the highest AUC: 0.88, P: <.001. GLS cutoff value ≤ -20.5 had 89.8% sensitivity, 84.6% specificity, 84.6% PPV, 89.8% NPV, and 87% diagnostic accuracy. Combining GLS cutoff with DSE had higher AUC than either alone (0.9, P < .001): 95.9% sensitivity, 84.6% specificity, 85.5% PPV, 95.7% NPV, and 90% diagnostic accuracy. CONCLUSION 2D-STE-derived GLS increases DSE precision to detect CAD in intermediate pretest probability patients: It improves DSE sensitivity, NPV, and accuracy. It is reproducible and has comparable specificity.