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Speckle-tracking echo detects coronary artery disease with 77% sensitivity and 75% specificityEchocardiography Shows Moderate Accuracy for Detecting Coronary Artery Disease
Frontiers in MedicinePublished August 28, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider STE with GLS as a moderate-accuracy, non-invasive option for CAD detection, but interpret with caution due to low certainty.
This meta-analysis pooled data from 40 non-randomized studies involving 5,296 participants with suspected coronary artery disease (CAD) to evaluate the diagnostic performance of speckle-tracking echocardiography (STE) myocardial strain parameters, using coronary angiography (CAG) as the reference standard.
Overall, STE demonstrated moderate diagnostic accuracy, with a pooled sensitivity of 77.3% (95% CI: 73.4–80.8%) and specificity of 75.0% (95% CI: 71.5–78.1%). Among the strain parameters, global longitudinal strain (GLS) showed the most robust performance, with a sensitivity of 78.6% (95% CI: 74.5–82.2%) and specificity of 76.3% (95% CI: 72.7–79.7%). Global area strain (GAS) had higher sensitivity (83.3%, 95% CI: 74.5–89.5%) but lower specificity (72.2%, 95% CI: 58.9–82.5%).
The authors noted substantial heterogeneity across studies, high risk of bias, indirectness, and imprecision. A GRADE assessment rated the overall certainty of evidence as low. These limitations mean the true diagnostic accuracy may differ from the pooled estimates.
In practice, STE may serve as a non-invasive adjunct for CAD detection, with GLS as the preferred parameter. However, given the low certainty, results should be interpreted alongside clinical context and other diagnostic tools.
How this fits prior evidence
This meta-analysis adds to prior coverage by addressing the diagnostic gap in coronary artery disease (CAD) detection. While prior items focused on treatment strategies (drug-coated balloons, stent types, antiplatelet therapy, and residual risk management), this review provides evidence on a non-invasive imaging modality. The moderate accuracy of STE (sensitivity 77.3%, specificity 75.0%) complements functional assessments like angiography-derived FFR, which met noninferiority for revascularization rates. It does not directly confirm or contrast prior findings but offers a diagnostic counterpart to the therapeutic advances previously covered.
Researchers looked at 40 different studies involving over 5,000 people to see how well speckle-tracking echocardiography (STE) works. This imaging technique measures how heart muscle moves to help find signs of coronary artery disease. The study compared these results against the standard method of coronary angiography.
The findings show that STE has moderate accuracy for diagnosing the condition. Specifically, the global longitudinal strain (GLS) measurement was found to be the most consistent of the different types of measurements tested. Other measurements, like global area strain (GAS), also showed results but had different levels of accuracy.
Because the evidence comes from non-randomized studies and has a high risk of bias, the results should be viewed with caution. The data is currently not strong enough to change how doctors treat patients today. It shows that while this imaging tool can provide useful information, it is not yet a perfect replacement for standard tests.
What this means for you:
Speckle-tracking echocardiography shows moderate accuracy in detecting coronary artery disease, especially using GLS.
Common questions
How accurate is speckle-tracking echocardiography for heart disease?
The study found that speckle-tracking echocardiography has moderate diagnostic accuracy for coronary artery disease. Specifically, it showed a sensitivity of 77.3% and a specificity of 75.0% overall. The global longitudinal strain (GLS) was noted as the most robust parameter among the different measurements tested.
What is the difference between GLS and GAS measurements?
Both are types of strain measurements used in echocardiography. GLS showed a sensitivity of 78.6% and a specificity of 76.3%. GAS showed a higher sensitivity of 83.3% but a lower specificity of 72.2% when used to detect coronary artery disease.
Is this test a replacement for standard heart tests?
The evidence is currently limited and not enough to change standard medical practice. Because the studies included were not randomized and had a high risk of bias, you should talk to your doctor about how these tests fit into your specific care plan.
ObjectivesTo determine the diagnostic performance of various myocardial strain parameters obtained by speckle-tracking echocardiography for detecting coronary artery disease.MethodsPubMed, Embase, Web of Science, and Cochrane Library were systematically searched from inception to 1 September 2025. Eligible studies included patients with suspected CAD, used CAG as the reference standard, and reported STE-derived strain parameters (e.g., GLS, GCS, GRS, GAS). Methodological quality was assessed via QUADAS-2, and meta-analyses were performed using a bivariate hierarchical random-effects model in STATA 18.0.ResultsA total of 40 non-randomized studies involving 5,296 participants were included. The overall pooled sensitivity and specificity of STE for CAD were 77.3% (95% CI: 73.4–80.8%) and 75.0% (95% CI: 71.5–78.1%), respectively, with substantial heterogeneity across studies. Subgroup analyses suggested that global longitudinal strain (GLS) had more optimal performance (sensitivity: 78.6%, 95% CI: 74.5–82.2%; specificity: 76.3%, 95% CI: 72.7–79.7%), while global area strain (GAS) showed the highest sensitivity (83.3%, 95% CI: 74.5–89.5%) but moderate specificity (72.2%, 95% CI: 58.9–82.5%). Exercise stress STE demonstrated higher sensitivity than dobutamine stress or no stress protocols, and recovery-phase measurements showed promising but imprecise results. Deek's funnel plot indicated no significant publication bias (P = 0.202). GRADE assessment rated the overall certainty of evidence as low due to high risk of bias, indirectness, and imprecision.ConclusionSTE exhibits moderate diagnostic accuracy for CAD, with GLS being the most robust parameter. Future research should focus on standardizing methodologies, validating strain thresholds, and integrating STE into multidisciplinary diagnostic pathways.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251207466.
