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Peer-reviewedCC BYCardiovascular ultrasound

Time-aligned segmental strain as a diagnostic marker for obstructive coronary artery disease in patients with chronic chest pain.

  • Assami Rösner1,2
  • Hatice Akay Caglayan3,4
  • Mehran Jazbani5
  • Semra Øztemel Sari3
  • Pablo Marti Castellote6
  • Didrik Kjønås3,4,7
  • Sandro Queirós8,9
9 affiliations
  1. 1Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, 9019, Norway. [email protected].
  2. 2Department of Clinical Medicine (IKM), UiT The Arctic University of Norway, Tromsø, 9019, Norway. [email protected].
  3. 3Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, 9019, Norway.
  4. 4Department of Clinical Medicine (IKM), UiT The Arctic University of Norway, Tromsø, 9019, Norway.
  5. 5Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
  6. 6Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra (UPF), Barcelona, Spain.
  7. 7Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway.
  8. 8Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
  9. 92Ai - Applied Artificial Intelligence Laboratory, School of Technology, Polytechnic University of Cávado and Ave (IPCA), Barcelos, Portugal.
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Abstract

Background

Myocardial strain curves provide valuable insights into coronary artery disease (CAD) beyond conventional peak strain measurements. This study aimed to evaluate the diagnostic utility of time-aligned segmental strain and strain rate (S/SR) curves to identify obstructive CAD in consecutive chest pain patients.Methods

A total of 510 chest-pain patients referred to coronary computed tomography angiography (CCTA) were included. Segmental strain curves were time-aligned using aortic valve closure (AVC) and cardiac cycle length as reference points. Average S/SR curves were generated for 18 myocardial segments, establishing reference curves from a group of 314 chronic chest-pain patients without CAD (No-CAD). Deviations were defined based on thresholds of peak S/SR or average S/SR curve deviation over systole and the first half of diastole.Results

Significant differences were observed between groups, particularly between the revascularized MI, CABG, or 3-vessel CAD groups compared to the No-CAD group (p<0.05). ROC curve analysis demonstrated excellent diagnostic performance for CABG patients (AUC up to 0.933), while the detection rate for PCI was limited (AUC < 0.7). Global longitudinal strain rate in early diastole (GLSR E) and segmental peak SR E showed the highest diagnostic accuracy. These findings confirm that time-aligned strain analysis improves the detection of significant CAD but remains limited for identifying patients with mild disease.Conclusion

Time-aligned segmental strain analysis improved detection of high-grade disease requiring CABG but could not distinguish single-vessel from non-obstructive CAD. Pathological strain patterns became significant only in advanced CAD, indicating that segmental resting strain analysis has clinical utility primarily for identifying advanced CAD.

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Cite

BibTeXRIS
BibTeX
@article{rosner2026timealigned,
  title = {{Time-aligned segmental strain as a diagnostic marker for obstructive coronary artery disease in patients with chronic chest pain.}},
  author = {Assami Rösner and Hatice Akay Caglayan and Mehran Jazbani and Semra Øztemel Sari and Pablo Marti Castellote and Didrik Kjønås and Sandro Queirós},
  journal = {Cardiovascular ultrasound},
  year = {2026},
  month = oct,
  doi = {10.1186/s12947-026-00388-0},
  url = {https://europepmc.org/article/MED/42894238},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Time-aligned segmental strain as a diagnostic marker for obstructive coronary artery disease in patients with chronic chest pain.
AU  - Assami Rösner
AU  - Hatice Akay Caglayan
AU  - Mehran Jazbani
AU  - Semra Øztemel Sari
AU  - Pablo Marti Castellote
AU  - Didrik Kjønås
AU  - Sandro Queirós
PY  - 2026
DA  - 2026/10/19
JO  - Cardiovascular ultrasound
DO  - 10.1186/s12947-026-00388-0
UR  - https://europepmc.org/article/MED/42894238
AB  - Background  Myocardial strain curves provide valuable insights into coronary artery disease (CAD) beyond conventional peak strain measurements. This study aimed to evaluate the diagnostic utility of time-aligned segmental strain and strain rate (S/SR) curves to identify obstructive CAD in consecutive chest pain patients.Methods  A total of 510 chest-pain patients referred to coronary computed tomography angiography (CCTA) were included. Segmental strain curves were time-aligned using aortic valve closure (AVC) and cardiac cycle length as reference points. Average S/SR curves were generated for 18 myocardial segments, establishing reference curves from a group of 314 chronic chest-pain patients without CAD (No-CAD). Deviations were defined based on thresholds of peak S/SR or average S/SR curve deviation over systole and the first half of diastole.Results  Significant differences were observed between groups, particularly between the revascularized MI, CABG, or 3-vessel CAD groups compared to the No-CAD group (p<0.05). ROC curve analysis demonstrated excellent diagnostic performance for CABG patients (AUC up to 0.933), while the detection rate for PCI was limited (AUC < 0.7). Global longitudinal strain rate in early diastole (GLSR E) and segmental peak SR E showed the highest diagnostic accuracy. These findings confirm that time-aligned strain analysis improves the detection of significant CAD but remains limited for identifying patients with mild disease.Conclusion  Time-aligned segmental strain analysis improved detection of high-grade disease requiring CABG but could not distinguish single-vessel from non-obstructive CAD. Pathological strain patterns became significant only in advanced CAD, indicating that segmental resting strain analysis has clinical utility primarily for identifying advanced CAD.
SN  - 1476-7120
ER  -