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Early diastolic strain rate by two-dimensional speckle tracking echocardiography is a predictor of coronary artery disease and cardiovascular events in stable angina pectoris

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Abstract

This study aimed to clarify the diagnostic and prognostic potential of strain rate in patients with suspected stable angina pectoris (SAP). Strain rate by 2-dimensional speckle tracking echocardiography (2DSTE) has been suggested to be able to diagnose coronary artery disease (CAD) and predict cardiovascular events in various patient groups. Prospectively enrolled patients (n = 296) with suspected SAP, no previous cardiac disease, and normal left ventricular ejection fraction were examined by 2DSTE, exercise ECG, and coronary angiography. Obstructive CAD was defined as stenosis ≥ 70% in ≥ 1 coronary artery on coronary angiography (n = 107). Major adverse cardiac events (MACE) included myocardial infarction, heart failure, atrial fibrillation, and stroke. In multivariable analysis adjusted for baseline data, conventional echocardiography, and Duke score, early diastolic strain rate (SRe) was independently associated with significant CAD with a 1.35 increased risk of having CAD per 0.1 decrease in SRe (OR = 1.35, 95% CI 1.03–1.76, P = 0.027). Peak velocity of early diastolic filling (E)/SRe was not associated with significant CAD (OR = 1.14, 95% CI 0.81–1.62, P  = 0.445). MACE occurred in 34 patients (12%) during follow-up (median 3.5 years) and both SRe (HR 1.26, 95% CI (1.07–1.49), P = 0.006) and E/SRe (HR 1.24, 95% CI (1.04–1.47), P = 0.017) were independent predictors after multivariable adjustment. In patients with suspected SAP, SRe by 2DSTE was independently associated with presence of CAD. In addition, SRe and E/SRe provided independent and incremental prognostic value for predicting future MACE.

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Acknowledgements

We would like to acknowledge Professor Jan Skov Jensens big contribution in conducting this study. It is with big sorrow that we had to say goodbye to our mentor and friend before publishing the results of the present report.

Funding

Tor Biering-Sørensen was supported by the Fondsbørsvekselerer Henry Hansen og Hustrus Hovedlegat 2016. The sponsors had no role in the study design, data collection, data analysis, data interpretation, or writing of the article.

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Authors and Affiliations

  1. Department of Cardiology, Faculty of Health Sciences, Gentofte Hospital, University of Copenhagen, Herlev & Kildegårdsvej 28, 2900, Hellerup, Denmark

    Rikke A. Hagemann, Philip Brainin, Christoffer A. Hagemann, Thomas Fritz-Hansen, Flemming J. Olsen, Rasmus Møgelvang & Tor Biering-Sørensen

  2. Department of Anaesthesiology and Intensive Care Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark

    Søren Hoffmann

  3. Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Tor Biering-Sørensen

  4. Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark

    Rikke A. Hagemann

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  1. Rikke A. Hagemann
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  2. Søren Hoffmann
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  3. Philip Brainin
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  4. Christoffer A. Hagemann
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Correspondence to Rikke A. Hagemann.

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Ethical approval

The study was approved by the regional Committee on Biomedical Research Ethics (J.No. H-C-2008-044) and was conducted according to the second Helsinki Declaration. All patients gave informed written consent.

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Hagemann, R.A., Hoffmann, S., Brainin, P. et al. Early diastolic strain rate by two-dimensional speckle tracking echocardiography is a predictor of coronary artery disease and cardiovascular events in stable angina pectoris. Int J Cardiovasc Imaging 36, 1249–1260 (2020). https://doi.org/10.1007/s10554-020-01822-8

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  • DOI: https://doi.org/10.1007/s10554-020-01822-8

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