Two-Dimensional Speckle-Tracking Echocardiography Combined With Stress Echocardiography in the Assessment of Coronary Artery Disease Patients Without Regional Wall Motion Abnormality.
BACKGROUND The detection of myocardial ischemia in coronary artery disease (CAD) patients who lack regional wall motion abnormality (RWMA) at rest remains a clinical challenge. Two-dimensional speckle-tracking echocardiography (2D-STE) provides a quantitative and sensitive means of evaluating myocardial function, whereas stress echocardiography (SE) is a well-validated modality for identifying myocardial ischemia. Using the Gensini score (GS), this study intended to assess the diagnostic utility of combining these two techniques in evaluating coronary lesion severity in the aforementioned patient population. METHODS A cohort of 128 patients undergoing coronary angiography (CAG) without resting regional wall motion abnormality (RWMA) was enrolled in the study. Regadenoson stress echocardiography was performed in all patients. Apart from conventional echocardiographic parameters, two-dimensional strain parameters were measured at both resting and peak stress states. According to the GS, patients were categorized into two groups: a nonsignificant stenosis group (GS ≤ 38) and a significant stenosis group (GS > 38). RESULTS No statistically significant differences were identified between the two groups in any conventional echocardiographic parameters or strain parameters measured at rest (p > 0.05). Significant intergroup differences in global longitudinal strain (GLS), GLS change from rest to stress (ΔGLS), global circumferential strain (GCS) change from rest to stress (ΔGCS), and wall motion score index (WMSI) were detected between the significant stenosis group and the nonsignificant stenosis group during regadenoson stress (all p < 0.05). In contrast, GCS, global radial strain (GRS), and GRS change from rest to stress(ΔGRS) failed to show significant between-group disparities (p > 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that ΔGLS exhibited the optimal diagnostic performance for identifying severe CAD (AUC = 0.928). Furthermore, a logical combination of ΔGLS and stress WMSI was employed to derive two diagnostic indicators with distinct clinical applicability. CONCLUSION Parameters obtained from 2D-STE combined with regadenoson SE demonstrate favorable diagnostic value for identifying severe CAD in patients without RWMA at rest. This approach may be particularly useful for special populations who are unable to undergo exercise stress testing or have chronic respiratory diseases and warrants further validation as a potential screening tool for significant coronary artery lesions in this patient cohort. Furthermore, the logical diagnostic combination based on ΔGLS and stress WMSI shows preliminary promise, although larger studies are needed to confirm its clinical applicability across diverse scenarios.