Two-dimensional Strain Echocardiography for Diagnosing Chest Pain in the Emergency Room: A Multicentre Prospective Study by the Israeli Echo Research Group

Eur Heart J Cardiovasc Imaging. 2017 Sep 1;18(9):1016-1024. doi: 10.1093/ehjci/jew168.


Aims: Left ventricular (LV) two-dimensional longitudinal strain (2DLS) analysis by echocardiography has been suggested as a useful tool for the detection of acute coronary syndromes (ACS). Our aim was to determine whether 2DLS analysis could assist in triage of patients with chest pain (CP) in the emergency department (ED).

Methods and results: We prospectively enrolled patients presenting to the ED with CP and suspected ACS but without a diagnostic ECG or elevated troponin. An echocardiogram was performed within 24 h of CP. For each patient, a histogram of LV myocardial peak systolic strain (PSS) was generated and the value identifying the 20% worst strain values (PSS20%) was determined. A predefined value of greater than -17% was considered abnormal. 2DLS analysis was available for 605 patients (mean age 58 ± 9 years, 70% males), of which 74 (12.2%) had ACS. During a 6-month follow-up, MACE occurred in 4 (5.8%) patients with and in 3 (0.6%) without ACS. An abnormal PSS20% was present in 60/74 patients with ACS (sensitivity 81%, negative predictive value 91%), but also in 391/531 patients without ACS (specificity 26%, positive predictive value 13%). Similar results were found for global longitudinal strain (GLS). Receiver-operating characteristic curves showed an area under curve of 0.59 for PSS20% and 0.6 for GLS (P= 0.3). Independent predictors of abnormal 2DLS were male gender, body mass index, heart rate, and mean tissue Doppler e', but not ACS.

Conclusion: In this large multicentre prospective study, 2DLS was not a useful tool to rule out ACS in the ED.

Clinical trial registration:

Unique identifier: NCT01163019.

Keywords: acute coronary syndrome; chest pain; emergency department; longitudinal strain; speckle tracking echocardiography.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / diagnostic imaging*
  • Acute Coronary Syndrome / mortality
  • Aged
  • Chest Pain / diagnosis
  • Chest Pain / diagnostic imaging*
  • Chest Pain / mortality
  • Cohort Studies
  • Diagnosis, Differential
  • Echocardiography*
  • Emergency Service, Hospital
  • Female
  • Follow-Up Studies
  • Humans
  • Israel
  • Male
  • Middle Aged
  • Odds Ratio
  • Prospective Studies
  • ROC Curve
  • Risk Assessment
  • Severity of Illness Index
  • Survival Rate
  • Symptom Assessment / methods*