Time-aligned segmental strain as a diagnostic marker for obstructive coronary artery disease in patients with chronic chest pain
Year: 2026
Type: article
Abstract: Background Myocardial strain curves provide valuable insights into coronary artery disease (CAD) beyond conventional peak strain measurements. This study aimed to evaluate the diagnostic utility of time-aligned segmental strain and strain rate (S/SR) curves to identify obstructive CAD in consecutive chest pain patients. Methods A total of 510 chest-pain patients referred to coronary computed tomography angiography (CCTA) were included. Segmental strain curves were time-aligned using aortic valve closure (AVC) and cardiac cycle length as reference points. Average S/SR curves were generated for 18 myocardial segments, establishing reference curves from a group of 314 chronic chest-pain patients without CAD (No-CAD). Deviations were defined based on thresholds of peak S/SR or average S/SR curve deviation over systole and the first half of diastole. Results Significant differences were observed between groups, particularly between the revascularized MI, CABG, or 3-vessel CAD groups compared to the No-CAD group (p<0.05). ROC curve analysis demonstrated excellent diagnostic performance for CABG patients (AUC up to 0.933), while the detection rate for PCI was limited (AUC < 0.7). Global longitudinal strain rate in early diastole (GLSR E) and segmental peak SR E showed the highest diagnostic accuracy. These findings confirm that time-aligned strain analysis improves the detection of significant CAD but remains limited for identifying patients with mild disease. Conclusion Time-aligned segmental strain analysis improved detection of high-grade disease requiring CABG but could not distinguish single-vessel from non-obstructive CAD. Pathological strain patterns became significant only in advanced CAD, indicating that segmental resting strain analysis has clinical utility primarily for identifying advanced CAD.
Source: Cardiovascular Ultrasound
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,990
OpenAlex ID: W7222889364