Abstract: Objective To evaluate the left ventricular myocardial mechanics in elderly patients with coronary heart disease (CHD) without no regional wall motion abnormalities (RWMA)at rest using three-dimensional speckle tracking imaging (3D-STI), and to determine the technique's efficacy in evaluating the serious degree of CHD, as quantified by the Gensini score (GS). Methods A total of 56 elderly patients with normal left ventricular ejection fraction and no RWMA who underwent coronary angiography (CAG) were enrolled in this study. Each participant underwent both standard echocardiographic examination and three-dimensional speckle tracking echocardiographic assessment. The patients were divided into two groups according to the Gensini score(GS): the non-significant stenosis group (GS≤38, n=25) and the significant stenosis group(GS>38, n=31) .General clinical data, standard echocardiographic measurements, and strain parameters derived from 3D-STI were compared between the two groups. The correlations between 3D-STI parameters and GS were analyzed. The diagnostic efficacy of 3D-STI parameters for severe CHD (GS>38) was evaluated using the receiver operating characteristic (ROC) curve. Results There were statistically significant differences in global area strain (GAS) and global longitudinal strain (GLS) between the two groups (P<0.05). However, global circumferential strain (GCS) and global radial strain (GRS) showed no significant differences between the two groups (P>0.05). A significant positive correlation was identified between the GS and both GAS (r=0.715, P<0.001) and GLS (r=0.671, P< 0.01).ROC curve analysis revealed that GAS had high diagnostic value for identifying severe CHD, with a cut-off value of -28.5%, a sensitivity of 93.5%, and a specificity of 72.0% (AUC=0.912). For GLS, a cut-off value of -16.5% provided a sensitivity of 61.3% and a specificity of 80.0% for detecting severe CHD, corresponding to an AUC of 0.791. Conclusions In the elderly patients with CHD without RWMA, left ventricular myocardial strain parameters measured by 3D-STI show certain characteristic changes and are closely associated with the severity of coronary artery lesions. Among these parameters, GAS demonstrates good evaluative efficacy and may serve as an effective non-invasive predictor for the severity of coronary artery lesions.

Key words: three-dimensional speckle tracking imaging, coronary artery disease, Gensini score, aged