Time-aligned segmental strain detects advanced CAD but misses mild disease

In 510 chest-pain patients having coronary CT angiography, time-aligned segmental strain detected advanced coronary artery disease requiring bypass surgery (AUC up to 0.933) but was limited for PCI (AUC <0.7) and could not separate single-vessel from non-obstructive disease.

• Early-diastolic global longitudinal strain rate (GLSR E) and segmental peak strain rate E showed the highest diagnostic accuracy among strain parameters.
• Time-aligned strain significantly differed for revascularized myocardial infarction, bypass grafting, or three-vessel coronary artery disease versus no coronary artery disease (p<0.05).
• Resting segmental strain analysis appears clinically useful mainly for advanced CAD; it could not distinguish single-vessel from non-obstructive disease.

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