Global longitudinal strain during stress echocardiography predicts major adverse cardiovascular events in patients with suspected chronic coronary syndrome.

Abstract Background Global longitudinal strain (GLS) is a robust prognostic marker in patients with coronary artery disease. The ABCDE stress echocardiography protocol has emerged as a novel tool for prognostic risk stratification beyond wall motion abnormalities. However, GLS during stress has not been incorporated in this protocol and its prognostic value remains to be confirmed. Purpose To assess the prognostic value of GLS during stress echocardiography to predict major adverse cardiovascular events in patients with suspected chronic coronary syndrome. Methods We recruited patients aged 18 years or older from 2017 to 2023 with suspected chronic coronary syndrome, who underwent clinically indicated stress echocardiography. Semiautomatic GLS of the LV was measured at rest and during stress. We included all types of stress: semi-supine bicycle, dobutamine, and dipyridamole. Logistic regression analysis was performed to assess the association between GLS and major adverse cardiovascular events (MACE). Results Eighty-one patients were included, age 61 (28-86) years, 52 were male (64 %), 60% had history of hypertension, 40% diabetes, 27% obesity and 14% previous acute coronary syndrome. Resting LVEF was 57% (± 11) and GLS 16% (± 4). After a mean follow up of 34 months, 24 patients (29%) presented MACE. Patients with MACE had lower LVEF 53 ± 13% vs 59% ± 10% (p<0.0328) and lower GLS 13.9± 4.5% vs 16.9 ± 3.9% (p<0.0029) at baseline. On univariate logistic regression analysis stress GLS was related to the occurrence of MACE, p=0.04. ROC curve analysis using Youden index identified that a cut off value of stress GLS <17% had a 47% sensitivity, 87% specificity. The survival analysis showed a 77.7% survival rate for those with GLS <17% than for those with GLS >17% (p=0.044) over 34 months of follow-up. Conclusion In patients with suspected chronic coronary syndrome undergoing stress echocardiography GLS during stress is a predictor for MACE. The survival of patients with less of 17% of GLS was significantly minor with a sensitivity of 47.37% and a specificity of 87.5%. ROC curve(Above) and Kaplan Meier Curve. Table 1.