ABSTRACT Background: Conventional echocardiography identifies STEMI by regional wall motion abnormality (RWMA), but it still has a great challenge to identify other types of coronary artery disease (CHD). The Two-dimensional Speckle Tracking Echocardiography (2D-STE) makes up for some of the deficiency, especially by using the myocardial work which combined with the left ventricular pressure condition. By this way, the dysfunctional region of myocardium can be identified more accurately, which is expected to be a new non-invasive prediction method for CHD. Methods: According to the exclusion criteria, 140 patients who had received coronary angiography (CAG) were included in this study. According to the stenosis rate of coronary artery, the patients were divided into CHD group and control group. The predictive efficacy of GLS and GWI for severe coronary artery stenosis were compared by ROC curve. Then, the 140 patients were respectively re-grouped according to the stenosis rate of LAD, LCX and RCA three times. The regional GLS and GWI are recorded as GLS R and GWI R according to the PRI method described in this article. The efficacy of GLS R and GWI R in predicting severe coronary artery stenosis were compared. Certainly the prediction efficiency between PRI method and traditional method (using the value of GLS and GWI directly) were also compared. Results: In predicting severe coronary artery stenosis, compared with GLS R, GWI R showed significantly higher sensitivity (95.2% vs 70.2%) and similar specificity (87.5% vs 91.1%). In the aspect of identification of certain coronary artery with severe stenosis, the sensitivity of GWI R was significantly higher than GLS R in predicting severe stenosis of LAD, LCX, and RCA (LAD: 96.5% vs 64.9%; LCX: 65.6% vs 50.0%; RCA: 50% vs 20%). Compared with traditional method, the “positive region identification” method has higher AUC in the ROC curve. Conclusion: GWI is more sensitive than GLS in identifying patients with CHD that couldn’t be detected by conventional echocardiography and performs better in accurately disclosing the culprit coronary arteries with severe stenosis. Compared with the traditional method, the PRI method can be used to judge whether there is severe stenosis in any coronary artery more accurately and confidently. Keywords: echocardiography, speckle-tracking echocardiography, pressure-strain loop, myocardial work, global longitudinal strain, coronary artery disease, coronary artery stenosis

Background: Longitudinal strain is helpful in discriminating between cardiac amyloidosis and other causes of left ventricle hypertrophy. We aimed to compare left atrial strain between light chain cardiac amyloidosis (AL-CA) and hypertensive heart disease (HHD). Methods: Echocardiography was performed at 21 consecutive AL-CA patients, 56 HHD patients and 21 controls who were enrolled in the current study between April 2018 and January 2021. Echo PAC workstation was employed to analyze LA strain of all the participants. Standard echocardiographic parameters and LA strain parameters were compared between AL-CA and HHD patients. ROC curves were employed to assess the discriminating ability of LA strain. Results: LASr and LASct were significantly lower (21.03 vs 26.17, P =0.009, and 12.11 vs 15.51, P=0.009, respectively) in AL-CA group than those in HHD group, whereas LAScd and SD-TPS were similar between the two groups (P=0.17 and P=0.27, respectively). The cutoff points of LASr and LASct for discriminating between AL-CA and HHD were 19.53% and 11.34%, respectively. Conclusions: AL-CA patients had marked reductions in LASr and LASct. LA strain had additional value in differentiating AL-CA from HHD patients.

Objectives. We sought to evaluate the ability of left atrial strain and derived index to discriminate patients with HFpEF from individuals with risk factors of HFpEF. Methods and results. A total of n=389 patients with risk factors for HFpEF finally was prospectively enrolled into the study, 51 of them were diagnosed with HFpEF by ESC diagnostic criteria. 55 patients were undergone left ventricular catheterization, 35 of them with LVEDP elevated. Left atrial strain was measured in all patients. Compared patients without HFpEF, LASr and LASr/(E/e’) was lower in HFpEF; E/LASr, LAVi/LASr and LVMI/LASrwas higher in patients with HFpEF. After adjusted for hypertension, diabetes, chronic kidney disease, LVEF and NT-proBNP, multivariate logistic regression analyses showed that LASr and derived indexes(E/LASr, LASr/(E/e’), LAVi/LASr and LVMI/LASr) were still the predictors of HFpEF in their respective models. LASr had good diagnostic accuracy for HFpEF. Of the left atrial strain derived parameters, LVMI/LASr was the best discriminatory ability for HFpEF (AUC 0.796, cutoff value 5.2, specificity 82%, sensitivity 73%). LASr, LASr/(E/e’), LAVi/LASr and LVMI/LASr with higher AUC was superior to conventional echocardiographic measures of diagnosing HFpEF. LASr and derived indexes were incorporated into the ESC diagnostic criteria, LASr-HFA-PEF score system (AUC=0.804) had a higher detection rate of LVEDP≥16mmHg than the HFA-PEF score system (AUC=0.781). Conclusion. LASr and derived indexes with good accuracy beyond conventional echocardiographic parameters discriminate HFpEF from patients with risk factors of HFpEF. LASr and derived indexes incorporated into the ESC diagnostic criteria will improve the diagnostic efficiency.