Value of two-dimensional speckle-tracking echocardiography for diagnosing significant coronary stenosis in patients with negative dobutamine stress echocardiography

Abstract

Background: Detection of regional wall motion abnormalities during dobutamine stress echocardiography (DSE) is challenging and dependent on individual interpretation, which may reduce sensitivity and accuracy while increasing the false-negative rate. Two-dimensional speckle-tracking echocardiography (STE) during DSE is a highly sensitive method with the potential to detect false-negative cases among patients with negative DSE results. Aim: This study assessed the value of global longitudinal strain (GLS) and regional longitudinal strain (RLS) by two-dimensional STE to detect significant coronary stenosis (SCS) among patients with negative DSE. Methods: This cross-sectional study applied two-dimensional STE to 68 patients with negative DSE. They had stable angina suspected of chronic CAD according to the diagnostic criteria of the ESC 2024 and the Ministry of Health of Vietnam 2023. STE findings were compared against selective coronary angiography (DSA) and multi-slice computed tomography (MSCT). Results: In the early recovery, GLS and RLS reached highest value. GLS reached AUC = 0.968 and Sensitivity = 84.4%, Specificity = 97.2% at GLS > -16.5%; RLS/LAD reached AUC = 0.863 and Sensitivity = 84.6%, Specificity = 83.3% at RLS/LAD > -16.7%; RLS/RCA reached AUC = 0.863 and Sensitivity = 71.4%, Specificity = 80.6%; RLS/LCx reached AUC = 0.926 and Sensitivity = 90.0, Specificity = 83.3 at RLS/LCx > -12.6%. Conclusions: GLS and RLS measured during the early recovery phase are valuable in the assessment of coronary artery stenosis. STE-derived strain parameters may provide additional diagnostic information for significant stenosis across all three coronary artery territories in patients with negative DSE.