title: Differential effects of coronary artery stenosis on myocardial function: the value of myocardial strain analysis for the detection of coronary artery disease.
abstract: BACKGROUND
  Speckle-tracking imaging is a novel method for assessing left ventricular (LV) function and ischemic changes. The aim of this study was to assess the predictive value of two-dimensional longitudinal strain in the detection of longitudinal LV dysfunction and the identification of coronary artery disease (CAD) in patients hospitalized with angina.
  
  
  METHODS
  Two-dimensional strain software was extended to allow the analysis of numerous longitudinal strain traces in the entire left ventricle and generate a histogram of peak systolic strain (PSS) values for the left ventricle and for each coronary territory. In each histogram, the value of the 10% worst strain values (PSS(10%)) was determined. Global strain, segmental PSS, and PSS(10%) were analyzed in 97 patients hospitalized with angina and had normal LV function, who underwent coronary angiography, and 51 patients with low probability of CAD. Echocardiography was performed 2.9 ± 2 days after admission.
  
  
  RESULTS
  Sixty-nine patients had significant CAD on coronary angiography. Significant differences were observed in all strain parameters between patients with and without CAD. PSS(10%) showed the best accuracy in detecting CAD, with an area under the receiver operating characteristic curve of 0.85. The areas under the curve for global strain and segmental PSS were 0.80 and 0.76, respectively. The optimal cutoff for PSS(10%) was -13.9%, with sensitivity and specificity of 86% and 75%, respectively. PSS(10%) was better than segmental PSS in the detection of CAD in each coronary territory.
  
  
  CONCLUSIONS
  In patients hospitalized with angina who have significant CAD on coronary angiography, longitudinal systolic function is impaired. Histogram analysis improved the accuracy of longitudinal strain analysis in detecting global and regional impaired function.
authors.affiliation: Heart Institute, Kaplan Medical Center, Rehovot, Israel. sara_s@clalit.org.il
authors.forename: Sara
authors.initials: S
authors.lastname: Shimoni
authors.forename: Gera
authors.initials: G
authors.lastname: Gendelman
authors.forename: Oded
authors.initials: O
authors.lastname: Ayzenberg
authors.forename: Nahum
authors.initials: N
authors.lastname: Smirin
authors.forename: Peter
authors.initials: P
authors.lastname: Lysyansky
authors.forename: Orly
authors.initials: O
authors.lastname: Edri
authors.forename: Lisa
authors.initials: L
authors.lastname: Deutsch
authors.forename: Avraham
authors.initials: A
authors.lastname: Caspi
authors.forename: Zvi
authors.initials: Z
authors.lastname: Friedman
mesh_terms: D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D012372:ROC Curve; D012720:Severity of Illness Index; D016277:Ventricular Function, Left