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11.11.2017 | Original Paper | Ausgabe 4/2018

The International Journal of Cardiovascular Imaging 4/2018

Two-dimensional speckle-tracking global longitudinal strain in high-sensitivity troponin-negative low-risk patients with unstable angina: a “resting ischemia test”?

The International Journal of Cardiovascular Imaging > Ausgabe 4/2018
Patrícia Marques-Alves, Nuno Espírito-Santo, Rui Baptista, Rogério Teixeira, Rui Martins, Francisco Gonçalves, Mariano Pego
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10554-017-1269-x) contains supplementary material, which is available to authorized users.


With the introduction of high-sensitivity troponin (hsTNI) assays, the clinical significance unstable angina (UA) has become uncertain. We hypothesized that impaired left ventricular (LV) two-dimensional speckle-tracking echocardiography (2D-STE)-derived peak global longitudinal strain (GLS) was able to exclude the presence of significant coronary artery disease (CAD) in UA patients without prior cardiovascular (CV) events and with a normal LV ejection fraction (LVEF). From a cohort of 200 patients admitted with UA, we selected 61 patients without prior CV events and with a normal LVEF; of these, 48 (79%) underwent invasive coronary angiography (ICA) and 24 (39%) had at least ≥ 1 significant stenosis. 2D-STE LV GLS analysis was performed offline using a dedicated automated software program. The mean patient age was 61 ± 12 years and 66% were male. Among the 48 patients selected to undergo ICA, those without significant CAD had a better 2D-STE GLS (− 19.4 vs. − 15.9%, P < 0.001). A cutoff of − 17.5% had a sensitivity of 87% and a specificity of 82% for differentiating UA patients without significant stenosis (AUC 0.86, P < 0.001). Patients who did not undergo ICA had a better GLS (− 20.2 vs. − 17.7%, P = 0.017). 2D-STE GLS had a significantly better discriminative power compared with LVEF (P < 0.001) and the GRACE score (P < 0.001) for identifying patients with significant CAD. Impaired values of 2D-STE LV GLS were significantly associated with the presence of CAD in hsTnI-negative UA patients and demonstrated better discriminative power than LVEF and the GRACE score.

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Supplemental Appendix 1: Bland-Altman plots for inter- and intra-observer variability. (TIF 888 KB)
Supplementary material 2 (TIF 903 KB)
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