title: Visual assessment vs. strain imaging for the detection of critical stenosis of the left anterior descending coronary artery in patients without a history of myocardial infarction.
abstract: OBJECTIVE
  We sought to determine the prevalence of overt and subclinical LV dysfunction in patients with critical left anterior descending coronary artery (LAD) stenosis but without a history of myocardial infarction and to compare diagnostic value of routine echocardiographic parameters with myocardial strain analysis for detection of critical LAD stenosis.
  
  
  RESULTS
  We retrospectively studied 269 patients with suspected coronary artery disease (CAD)-209 consecutive patients with critical LAD stenosis and 60 consecutive patients with atypical chest pain and without CAD. Conventional visual assessment of LV asynergy in the LAD territory was compared with global, regional, and segmental peak systolic longitudinal strain (PSLS) parameters derived by two-dimensional speckle tracking echocardiography (2D STE). Wall motion abnormalities in the LAD territory were found in 41% of patients with critical LAD stenosis, whereas, depending on the cut-off value, global longitudinal strain (GLS) was impaired in 42-69% of patients. GLS with an area under the receiver operating characteristic curve (AUC) of 0.85 showed better discriminative power for detecting critical LAD stenosis than conventional wall motion score index (AUC 0.73, P < 0.05, for the difference between the AUCs). PSLS values were significantly lower in basal and midventricular segments supplied by critically narrowed LAD, particularly if they also appeared dysfunctional on visual assessment.
  
  
  CONCLUSIONS
  Detection of subclinical LV dysfunction by 2D STE might improve identification of patients with critical LAD stenosis, although visually apparent regional LV dysfunction in the LAD territory is not uncommon finding in this subset of patients.
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia future.ivan@gmail.com.
authors.forename: Ivan
authors.initials: I
authors.lastname: Stankovic
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia.
authors.forename: Biljana
authors.initials: B
authors.lastname: Putnikovic
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia.
authors.forename: Radosava
authors.initials: R
authors.lastname: Cvjetan
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Milicevic
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia.
authors.forename: Milos
authors.initials: M
authors.lastname: Panic
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia.
authors.forename: Tijana
authors.initials: T
authors.lastname: Kalezic-Radmili
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia.
authors.forename: Tijana
authors.initials: T
authors.lastname: Mandaric
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia.
authors.forename: Radosav
authors.initials: R
authors.lastname: Vidakovic
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia.
authors.forename: Vojkan
authors.initials: V
authors.lastname: Cvorovic
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia.
authors.forename: Aleksandar N
authors.initials: AN
authors.lastname: Neskovic
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D004452:Echocardiography / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055771:Serbia / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging
keywords: Coronary artery disease; Longitudinal strain; Speckle tracking