Citation: Md. Saqif Shahriar, Tuhin Haque, Md. Badiuzzaman, Ashraf Ur Rahman, Hasanur Rahman, Umme Shaila. Strain Analysis Using Speckle Tracking Echocardiography for Detection of Coronary Artery Disease in Stable Angina Patients with No Regional Wall Motion Abnormality at Rest. Sch J App Med Sci, 2022 Oct 10(10): 1628-1635. 1628 Scholars Journal of Applied Medical Sciences Abbreviated Key Title: Sch J App Med Sci ISSN 2347-954X (Print) | ISSN 2320-6691 (Online) Journal homepage: https://saspublishers.com Strain Analysis Using Speckle Tracking Echocardiography for Detection of Coronary Artery Disease in Stable Angina Patients with No Regional Wall Motion Abnormality at Rest Md. Saqif Shahriar 1* , Tuhin Haque 2 , Md. Badiuzzaman 2 , Ashraf Ur Rahman 1 , Hasanur Rahman 3 , Umme Shaila 4 1 Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Sher-E- Bangla Nagor, Dhaka, Bangladesh 2 Department of Cardiology, National Heart Foundation Hospital and research Institute (NHF & RI), Dhaka, Bangladesh 3 Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh 4 Department of Biochemistry, Sir Salimullah Medical College and Mitford Hospital (SSMC & MH), Dhaka, Bangladesh DOI: 10.36347/sjams.2022.v10i10.008 | Received: 27.08.2022 | Accepted: 02.10.2022 | Published: 07.10.2022 *Corresponding author: Md. Saqif Shahriar Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Sher-E- Bangla Nagor, Dhaka, Bangladesh Abstract Original Research Article Background: Speckle-tracking imaging is a novel method for assessing left ventricular (LV) function and ischemic changes. The aim of this study was to predict the presence of coronary artery disease by longitudinal 2D strain analysis using speckle tracking echocardiography in patients with stable or unstable angina with no regional wall motion abnormality at rest. Objectives: Objective of this study is to predict the presence of significant CAD in a patient with no regional wall motion abnormality by longitudinal 2D strain analysis using speckle tracking echocardiography. Methods: This cross-sectional study included a total 66 patients (mean age, 51.92±8.9 years) with suspected CAD without RWMA on resting echocardiography who underwent coronary angiography. Longitudinal 2D strain analysis by STE was performed in all patients before coronary angiography. Global and segmental peak systolic longitudinal strain (PSLS) were recorded & computed by offline dedicated software semi-automatically on bull’s-eye report. The patients were divided into two groups according to the coronary angiographic findings; group- I: significant CAD on coronary angiogram (n=35), group-II: normal coronaries on CAG (n=31).All the baseline characteristics and outcome were then compared between the two groups. Results: PSLSs of all left ventricular segments were obtained successfully in 66 patients. PSLS (both global and segmental) was significantly decreased in patients with significant CAD on CAG group. Receiver operating characteristic (ROC) curve analysis demonstrated that global PSLSs could effectively detect patients with CAD (area under ROC curve = 0.877, 95% CI=0.749–0.960). According to ROC curve analysis, -18.77% appeared to be a good cutoff value for predicting those with significant CAD (specificity 77.4% and sensitivity 82.9%). Conclusion: Global and segmental PSLS using speckle tracking echocardiography at rest was significantly lower in patients with CAD without RWMA, and might be useful for identifying patients with a significant CAD with good degree of sensitivity and specificity. Keywords: Speckle tracking echocardiography, Peak systolic longitudinal strain, Coronary artery disease. Copyright © 2022 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited. INTRODUCTION Coronary artery disease (CAD) is a major cause of death and is a global health problem reaching epidemic in both developed as well as in developing countries [1]. Early detection of coronary artery disease is very important to combat cardiovascular morbidity & mortality and may often influence treatments and establish prognosis [2]. The echocardiographic assessment of regional myocardial function plays a critical role in the diagnosis and management of ischemic heart disease [3]. During recent years, velocity imaging, displacement imaging and deformation imaging (strain and strain-rate imaging) have emerged as valuable tools for more comprehensive and reliable echocardiographic assessment of myocardial function [4]. The recently introduced 2D strain modality opens entirely new possibilities for advanced, real-time analysis of myocardial wall motion. The new modality Cardiology