Global longitudinal strain reflects angiographic severity of coronary artery disease: A Case Series

Background: Global longitudinal strain (GLS) is a sensitive marker of subendocardial myocardial dysfunction and may detect ischemia earlier than left ventricular ejection fraction (LVEF). Its relationship with angiographic severity of coronary artery disease (CAD) in routine clinical practice remains an area of clinical interest.

Methods: This case series included 15 consecutive patients with suspected or established CAD who underwent two-dimensional speckle-tracking echocardiography and coronary angiography at a tertiary care center. GLS was measured in accordance with American Society of Echocardiography recommendations. LVEF was assessed using Simpson’s method. CAD severity was characterized based on angiographic findings and categorized descriptively. Clinical, echocardiographic, and angiographic data were analyzed descriptively without inferential statistical testing.

Results: The cohort comprised predominantly male patients (≈80%) with a mean age of approximately 58–62 years. Clinical presentations included ST-elevation myocardial infarction, non-ST elevation myocardial infarction, and chronic stable angina. LVEF ranged from approximately 44% to 65%, with several patients demonstrating preserved or mildly reduced systolic function.

GLS values ranged from approximately −9% to −19%. A descriptive trend was observed in which patients with more extensive coronary artery disease demonstrated relatively impaired (less negative) GLS values. Patients with acute myocardial infarction and multivessel disease tended to have GLS values in the range of approximately −9% to −12%, whereas those with less extensive disease demonstrated relatively preserved GLS (approximately −16% to −19%).

Notably, reduced GLS was observed in several patients with preserved LVEF (>50%), suggesting the presence of subclinical myocardial dysfunction not detected by conventional systolic measures.

Conclusion: In this small consecutive case series, GLS appeared to worsen with increasing angiographic severity of coronary artery disease and identified myocardial dysfunction despite preserved LVEF. These findings are descriptive and hypothesis-generating, supporting further evaluation of GLS in larger prospective studies