Time-aligned segmental strain analysis improved detection of high-grade disease requiring CABG but could not distinguish single-vessel from non-obstructive CAD, so segmental resting strain analysis has clinical utility primarily for identifying advanced CAD.
Key Findings
Methods
Time-aligned segmental strain and strain rate (S/SR) curves were built from 510 chest-pain patients referred for CCTA, using a No-CAD reference group of 314 patients.
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, with reference curves established from 314 chronic chest-pain patients without CAD (No-CAD).
Deviations were defined by thresholds of peak S/SR or average S/SR curve deviation over systole and the first half of diastole.
Results
Strain measures differed significantly between the No-CAD group and the more advanced disease groups.
Significant differences were seen particularly between the revascularized MI, CABG, or 3-vessel CAD groups and the No-CAD group (p<0.05).
Results
Diagnostic performance was excellent for identifying CABG patients.
ROC curve analysis gave AUC values of up to 0.933 for CABG patients.
Results
Detection of PCI patients was limited.
ROC analysis showed AUC < 0.7 for the PCI group.
Results
Early diastolic strain rate parameters showed the highest diagnostic accuracy.
Global longitudinal strain rate in early diastole (GLSR E) and segmental peak SR E showed the highest diagnostic accuracy.
Conclusions
Time-aligned strain analysis improves detection of significant CAD but remains limited for mild disease.
The method could not distinguish single-vessel from non-obstructive CAD.
Pathological strain patterns became significant only in advanced CAD.
Conclusions
Segmental resting strain analysis has clinical utility primarily for identifying advanced CAD.
Limited ability to detect milder disease such as PCI-treated or single-vessel CAD restricts its use for early or mild disease.
What This Means
This study looked at whether detailed analysis of how the heart muscle moves and deforms during each heartbeat (called strain), measured by ultrasound at rest, could help identify blocked heart arteries in people with chest pain. The researchers studied 510 patients referred for a CT scan of their coronary arteries. They aligned strain curves in time for 18 heart segments and compared each patient to a reference built from 314 patients without coronary disease.
The approach worked well for patients with advanced disease. People who had had bypass surgery (CABG), had revascularized heart attacks, or had three-vessel disease showed clearly different strain patterns from those without disease, and the method identified bypass patients very well (AUC up to 0.933). Measures of how quickly the heart muscle relaxes in early diastole were the most useful. However, the method did poorly for patients treated with stents (PCI, AUC under 0.7) and could not separate single-vessel from non-obstructive disease.
This research suggests that resting strain analysis may be most useful as a tool for flagging advanced coronary disease rather than for detecting milder or early disease. It does not appear to be a stand-alone test to rule out smaller blockages in people with chest pain.
Rösner A, Caglayan H, Jazbani M, Sari S, Castellote P, Kjønås D, et al.. (2026). Time-aligned segmental strain as a diagnostic marker for obstructive coronary artery disease in patients with chronic chest pain.. Cardiovascular ultrasound. https://doi.org/10.1186/s12947-026-00388-0