title: Detection of Obstructive Coronary Artery Disease Using Peak Systolic Global Longitudinal Strain Derived by Two-Dimensional Speckle-Tracking: A Systematic Review and Meta-Analysis.
abstract: Global longitudinal strain (GLS) is well validated and has important applications in contemporary clinical practice. The aim of this analysis was to evaluate the accuracy of resting peak GLS in the diagnosis of obstructive coronary artery disease (CAD).
  
  
  
  A systematic literature search was performed through July 2015 using four databases. Data were extracted independently by two authors and correlated before analyses. Using a random-effect model, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and summary area under the curve for GLS were estimated with their respective 95% CIs.
  
  
  
  Screening of 1,669 articles yielded 10 studies with 1,385 patients appropriate for inclusion in the analysis. The mean age and left ventricular ejection fraction were 59.9 years and 61.1%. On the whole, 54.9% and 20.9% of the patients had hypertension and diabetes, respectively. Overall, abnormal GLS detected moderate to severe CAD with a pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 74.4%, 72.1%, 2.9, and 0.35 respectively. The area under the curve and diagnostic odds ratio were 0.81 and 8.5. The mean values of GLS for those with and without CAD were -16.5% (95% CI, -15.8% to -17.3%) and -19.7% (95% CI, -18.8% to -20.7%), respectively. Subgroup analyses for patients with severe CAD and normal left ventricular ejection fractions yielded similar results.
  
  
  
  Current evidence supports the use of GLS in the detection of moderate to severe obstructive CAD in symptomatic patients. GLS may complement existing diagnostic algorithms and act as an early adjunctive marker of cardiac ischemia.
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia. Electronic address: kevin.liou@health.nsw.gov.au.
authors.forename: Kevin
authors.initials: K
authors.lastname: Liou
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Negishi
authors.affiliation: Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Suyen
authors.initials: S
authors.lastname: Ho
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Russell
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Cranney
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Sze-Yuan
authors.initials: SY
authors.lastname: Ooi
mesh_terms: D015984:Causality; D015897:Comorbidity; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology
keywords: Coronary artery disease; Global longitudinal strain; Speckle-tracking