Duration of Myocardial Early Systolic Lengthening Predicts the Presence of Significant Coronary Artery Disease

Objectives This study sought to investigate whether the duration of left ventricular (LV) early systolic lengthening could accurately identify patients with significant coronary artery disease (CAD). Background Ischemic myocardium with reduced active force will lengthen when LV pressure rises during early systole before onset of systolic shortening. Methods We included 88 patients with suspected CAD referred to elective diagnostic coronary angiography. Two of these patients were excluded from the study due to evidence of previous myocardial infarction on contrast-enhanced magnetic resonance imaging. Speckle tracking echocardiography was performed before coronary angiography and at follow-up scheduled 1 year after revascularization, and global longitudinal strain and duration of average LV early systolic lengthening were recorded. Results Forty-three of 86 patients had significant CAD. The duration of early systolic lengthening was significantly prolonged in patients with significant CAD compared with patients without significant coronary artery stenoses (76 +/- 37 ms vs. 38 +/- 23 ms, p < 0.001). Correspondingly, global systolic strain was significantly lower in patients with CAD (-17.7 +/- 3.0% vs. -19.5 +/- 2.6%, p = 0.003). Prolonged duration of early systolic lengthening showed the best accuracy in detecting CAD, with an area under the receiver-operating characteristic curve of 0.83. The area under the curve for global strain was 0.68. At 1-year follow-up, the duration of early systolic lengthening was significantly reduced (64 +/- 37 ms vs. 76 +/- 37 ms, p = 0.041) in the patients treated with revascularization. Conclusions Duration of myocardial early systolic lengthening was prolonged in patients with significant CAD; this might be a useful parameter to identify patients who might benefit from reperfusion therapy. (J Am Coll Cardiol 2012;60:1086-93) (c) 2012 by the American College of Cardiology Foundation