*Co esponding au ho : Akhil Meh o a
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Glago ’s phenomenon and limi a ions o co ona y CT angiog aphy in asymp oma ic
65 yea male wi h se e ely ele a ed Aga s on sco e: Case epo and li e a u e e iew
Akhil Meh o a 1, *, Mohammad Shaban 2 and Faiz Illahi Siddiqui 2
1 Chie , Pedia ic and Adul Ca diology, P akash Hea S a ion, Ni ala Naga , Lucknow, UP, India.
2 Ca diac Technician, P akash Hea S a ion, Ni ala Naga , Lucknow, UP, India.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 056-079
Publica ion his o y: Recei ed on 21 No embe 2024; e ised on 28 Decembe 2024; accep ed on 31 Decembe 2024
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.21.1.1097
Abs ac
Nonin asi e iden i ica ion o pa ien s wi h co ona y a e y disease (CAD) emains a clinical challenge despi e he
widesp ead use, and possible o e use, o imaging and p o oca i e es ing; mo e han 50% o pa ien s cu en ly e e ed
o co ona y angiog aphy show no mal o non-obs uc i e CAD.
E alua ion o co ona y a e y disease (CAD) using co ona y compu ed omog aphy angiog aphy (CTA) has seen a
pa adigm shi in he las decade. E idence inc easingly suppo s he clinical u ili y o CTA ac oss a ious s ages o CAD,
om he de ec ion o ea ly subclinical disease o he assessmen o acu e ches pain. Addi ionally, CTA can be used o
nonin asi ely quan i y plaque bu den and iden i y high- isk plaque, aiding in diagnosis, p ognosis, and ea men .
Co ona y a e y calcium (CAC) is a highly speci ic ea u e o co ona y a he oscle osis. CAC sco ing has eme ged as a
widely a ailable, consis en , and ep oducible means o assessing isk o majo ca dio ascula ou comes. Glago ’s
phenomenon o a e ial wall emodeling and nume ous limi a ions in he echnique o CTA may pose hinde ances in
he co ec es ima ion o obs uc i e CAD in se e ely and e y highly ele a ed Aga s on sco e.
Recen ly, he 2-dimensional Speckle T acking Echoca diog aphy (STE) has gained subs an ial clinical in e es . Le
en icula longi udinal s ain, de i ed using wo-dimensional speckle- acking echoca diog aphy, has eme ged as a
nonin asi e ma ke o bo h global and egional LV dys unc ion in pa ien s a isk o de eloping CAD. Cu en e idence
suppo s he use o global longi udinal s ain (GLS) in he de ec ion o mode a e o se e e obs uc i e CAD in
symp oma ic pa ien s. GLS may complemen exis ing diagnos ic algo i hms and ac as an ea ly adjunc i e ma ke o
ca diac ischemia.
He e, we a e p esen ing a 65 yea old asymp oma ic male wi h a no mal 2Dimensional echoca diog aphy and nega i e
eadmill s ess es (TST) du ing a ou ine heal h check up. The pa ien eques ed o CTA which demons a ed se e ely
ele a ed calcium sco e o 468 Aga s on uni s accompanied by ex ensi e iple essel disease. These non-in asi e es s
we e conduc ed a a local co po a e hospi al and hei ca diology consul an s sugges ed ei he a mul i essel
pe cu aneous co ona y in e en ion (PCI) wi h s en ing o iple essel co ona y a e y bypass g a ing (CABG). Hence,
he pa ien isi ed ou cen e o ob ain a de ini i e opinion ega ding e ascula iza ion.
Keywo ds: Ca diac compu ed omog aphy; Co ona y a e y calcium; Co ona y a e y disease; Global longi udinal
s ain
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1. In oduc ion
Ca dio ascula disease emains a global heal h conce n wi h p o ound implica ions o pa ien well-being and
heal hca e sys ems [1]. Co ona y a e y disease (CAD) is a majo con ibu o cha ac e ized by he de elopmen o
a he oscle osis, na owing he co ona y a e ies and es ic ing he blood low o he hea muscle [2]. E en be o e
o e symp oms, sub le changes in myoca dial unc ion may occu due o he p esence o a he oscle osis [3].
CT co ona y angiog aphy (CTA) is an eme ging ool o he non-in asi e assessmen o co ona y a e y disease. Se e al
expe consensus documen s endo se he use o CTA o excluding co ona y a e y disease (CAD) in symp oma ic
pa ien s wi h e e ence o nume ous s udies which ha e epo ed high nega i e p edic i e alues [4, 5]. Howe e ,
p edic i e alues hea ily depend on disease p e alence wi hin he s udy popula ion, hus hey canno be applied ou side
he con ex o a de ined pa ien g oup [6-8]. Acco dingly, an assessmen o p e es p obabili y o co ona y a e y disease
may help p edic ing he alue o CT angiog aphy o excluding o con i ming he p esence o CAD. In his ega d,
co ona y a e ial calci ica ion de ec ed by non-con as CT co ela es well wi h CAD p e alence and he e o e may help
o iden i y pa ien s in whom uling ou o con i ming CAD by CT angiog aphy is o low yield. Fu he mo e, co ona y
a e ial calci ica ion may also al e he diagnos ic pe o mance o CT angiog aphy [9-12].
The Aga s on Calcium Sco e is a quan i a i e measu e used in ca diac compu ed omog aphy (CCT) o assess he
co ona y a e y calcium bu den and can be employed o es ima e a pa ien ’s isk o ca dio ascula e en s and guide
ea men [13, 14] (Figu e 1, 2).
Figu e 1 Co ona y CT angiog aphy images in a no mal pa ien
(A)
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(B)
Figu e 2 (A) Co ona y calcium sco ing on co ona y CT angiog aphy; (B) Co ona y CT angiog aphy in pa ien s wi h 0
and 1292 Aga s on sco e
Co ona y calcium subs an ially a enua es X- ay pene a ion leading o "blooming" a i ac s wi h cu en CT image
econs uc ion ha may obscu e he co ona y lumen. Because o he pe cei ed limi a ion o CTA in pa ien s wi h se e e
co ona y calci ica ion, many in es iga o s ha e a o ed ob aining a co ona y calcium sco e o in o m he decision o
p oceeding o no wi h CTA [15] (Table 1).
Table 1 Aga s on sco e - absolu e alues
Absolu e alue (Aga s on uni s)
Ranking
0
Absen
> 0 < 10
Minimal
>10 < 100
Mild
> 100 < 400
Mode a e
> 400 < 1000
Se e e
> 1000
Ex ensi e
Classi ica ion o co ona y calcium absolu e con en e alua ed by ca diac CT and quan i ied by Aga s on uni s [16].
Howe e , he u iliza ion o a co ona y calcium sco e h eshold o deciding o pe o m o no co ona y CTA emains
con o e sial [17, 18].
Recen echnological ad ancemen s in echoca diog aphy ha e enabled supe io assessmen s o myoca dial unc ion
h ough global longi udinal s ain (GLS) analyses, o e ing a pa icula e unde s anding o subclinical myoca dial
dys unc ion [19]. 4Dimensional XS ain speckle acking echoca diog aphy (4DXS ainSTE) is a easible newe
echnology o e alua e global longi udinal s ain [20]. P e ious esea ch has demons a ed comp omised le
en icula unc ion pa ien s wi h signi ican CAD, as assessed h ough in asi e co ona y angiog aphy [21]. Howe e ,
whe he he ex en o inc emen al impai men GLS co esponds o inc easing CAC sco e emains unknown.
The in e play be ween he wo pa ame e s, ha is, CAC and GLS holds he po en ial o un a el sub le ies in he
in e ac ion be ween a he oscle osis and myoca dial pe o mance (Figu es 3, 4).
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Figu e 3 Schema ic diag am o myoca dial s ain on pos -p ocessing so wa e. (a, d, g) Images o di e en planes o
he ca diac; (b, e, h) images o adial s ain, ci cum e en ial s ain and longi udinal s ain; (c, , i) cu es o myoca dial
s ain and ime in he ca diac cycle
Figu e 4 Le en icula global longi udinal s ain assessmen using ea u e acking so wa e. Endoca dial bo de s
we e delinea ed on long-axis wo- (A), h ee- (B), and ou -chambe (C) SSFP cine images in end-sys ole and end-
dias ole. The inal au oma ic calcula ion was pe o med by he so wa e: he a e age GLS o all 17 ca diac segmen s in
his case was -5.09 (D)
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2. Case Repo
A 65 yea adul male p esen ed o ou ca diology OPD o a ou ine check up and discuss abou co ona y CT angiog am
epo which was conduc ed on himsel on 18-5-22, a e he had speci ically eques ed he hospi al o unde ake his
in es iga ion. Due o he cu en su ge in acu e co ona y synd ome in India, he wan ed o know he s a us o his
co ona y a e ies. Mo eo e , he pa ien in o med ha he was diagnosed hype ension ew yea s back, which was now
con olled on an ihype ensi es. He denied any his o y o o he ca dio ascula isk ac o s - smoking, obacco, chewing,
diabe es, dyslipidemia e c. He was cu en ly asymp oma ic and walking daily 30-45 minu es, 5 days/week.
On clinical examina ion, he pa ien was heal hy looking and no mally buil (Figu e 5). The pa ien ’s weigh was 61 kg,
heigh was 156 cm, pulse a e was 90/min, blood p essu e was 124/60 mmHg, espi a o y a e was 16/min and SPO2
was 99 % a oom ai . All he pe iphe al pulses we e no mally palpable wi hou any adio- emo al delay. Ca dio ascula
and sys emic examina ion we e no mal.
Figu e 5 Facial appea ance o ou index pa ien
X ay ches (PA) iew (Figu e 6) was ypically no mal and he ca diac size was wi hin no mal limi s.
Figu e 6 X- ay ches (PA iew). X ay ches (PA) showed no mal ca diac size wi h no mal pulmona y blood low
The es ing ECG (Figu e 7) was also no mal.
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Figu e 7 Res ing ECG. The es ing ECG was no mal. The e is no mal sinus hy hm wi h a en icula a e o 80/min
and no mal QRS axis
Aga s on sco e: 468 uni s
His CTA po ayed (Figu e 8):
CTA exhibi ed iple essel disease (TVD) wi h a calcium sco e o 468 Aga s on uni s
Le main co ona y a e y
Ci cum e en ial so plaque causing 20-30 % s enosis.
Le an e io descending co ona y a e y
• Os io-p oximal LAD showed 80-90 % s enosis ex ending om LAD os ium o he o igin o D2.
• Mid LAD e ealed 70-80 % s enosis.
• D2 os ium and he p oximal pa iden i ied 80-90% s enosis.
Le ci cum lex co ona y a e y
• P oximal LCX and OM2 os ium demons a ed 70-80 % and 80-90 % s enosis, espec i ely.
Righ co ona y a e y
• 70-80% s enosis was p esen in he p oximal RCA and > 90 % s enosis was de ec ed in he mid RCA.
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(A)
(B)
(C)
Figu e 8 126 Slice CT co ona y angiog aphy o ou pa ien . (A) CT o he hea ; (B) and (C) Co ona y CT angiog am-
Aga s on sco e was 468 uni s
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2.1. T ans ho acic Echoca diog aphy
All echoca diog aphy e alua ions we e pe o med by he au ho , using My Lab X7 4D XS ain echoca diog aphy
machine, Esao e, I aly. The images we e acqui ed using an adul p obe equipped wi h ha monic a iable equency
elec onic single c ys al a ay ansduce while he subjec was lying in supine and le la e al decubi us posi ions.
Con en ional M-mode, wo-dimensional, pulse wa e dopple (PWD) and con inuous wa e dopple (CWD)
echoca diog aphy was pe o med in he classical subcos al, pa as e nal long axis (LX), pa as e nal sho axis (SX), 4-
Chambe (4CH), 5-Chambe (5CH) and sup as e nal iews (Figu es 9-13).
2.2. M-mode Echoca diog aphy
M-mode echoca diog aphy o le en icle was pe o med and he es ima ed measu emen s a e ou lined (Table 2,
Figu e 9).
Table 2 Calcula ions o M-mode echoca diog aphy
Measu emen s
LV
IVS d
13.1 mm
LVID d
45.8 mm
LVPW d
5.5 mm
IVS s
17.6 mm
LVID s
28.6 mm
LVPW s
13.4 mm
EF
68 %
% LVFS
38 %
LVEDV
96.3 ml
LVESV
31.1 ml
SV
65.2 ml
LV Mass
143 g
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Figu e 9 M-mode measu emen s o le en icle
2.3. Summa y o M-mode echoca diog aphy
The LV was o no mal size and he LVEF was 68 %. Ven icula sep um ound o be hickened (D = 13.1 mm). The e was
no appa en egional wall mo ion abno mali y.
2.4. 2 Dimensional ans ho acic echoca diog aphy
2-Dimensional ans ho acic echoca diog aphy (2D TTE) was conduc ed in explici de ail, pa icula ly o look o any
egional wall mo ion abno mali ies o any al ula egu gi a ion.
Howe e , he 2D TTE was absolu ely no mal (Figu es 10-13). The e was no mal LV dimensions and sys olic unc ions
(Table 3):
• Simpson’s biplane me hod: LVEF was 69 % (Figu e 11A)
• 4Dimensional olume ic analysis by 4D XS ain STE: LVEF was 62.84 % (Figu e 11B)
We implemen ed wi h p ecision he GLS es ima ion by 4DXS ain STE (Table 4) and o ou dismay we ound no mal
alues o GLS (-17.22%) (Figu e 12D) and ime o peak endoca dial s ain (Figu e 13B) consis en wi h s ain alues o
heal hy adul s.
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3.5. Glago ’s Phenomenon
An excep ionally high co ona y calcium sco e, g ea e han 10,000 UA, supe io o any o he ound in he li e a u e
e iewed, was epo ed in an asymp oma ic, adul man wi h hype ension, obesi y and dyslipidemia, wi hou
myoca dial ischemia and no signi ica i e co ona y s enosis, associa ed o Glago 's phenomenon in he le co ona y
a e y [37]. The au ho s Cas o-Villaco a e al [37] concluded (Figu es 14-16):
In asymp oma ic pa ien s, a high CAC:
• Is no an equi alen o myoca dial ischaemia
• Is no an indica ion o in asi e co ona y angiog aphy
• A unc ion, es -s ess e alua ion by pe usion myoca dial SPECT imaging o any o he kind o non in asi e
es looking o ischemia would be an excellen app oach o selec he in ensi y o medical he apy and he
ype de ini i e managemen wi h high Aga s on sco e.
Figu e 14 Le la e al (A), an e io (B) and pos e io (C) 3-D iews in a s anda d non- con as ed ca diac omog aphy,
no mally used o ob ain he Aga s on sco e. No e he eno mous amoun s o calci ied a he oma along he co ona y ee
makes possible his olume ende ing econs uc ion showing all he epica dial segmen o he essels.
Figu e 15 Cu ed 2-D iews o LAD, RC and LCx in ca diac CT wi h con as , whe e se e e and ex ensi e calci ied
disease can be app ecia ed. The Glago ’s phenomenon in p oximal LAD is iden i ied by yellow a ow
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Figu e 16 No mal es /exe cise ga ed myoca dial SPECT imaging wi h sho , e ical,and ho izon al long axis (SA,
VLA, HLA) .The pe usion de ec a es in in e obasal egion (o ange a ows) showed in SA and VLA clea ly imp o es
du ing s ess ( blue a ows)
In ou index pa ien , we did pe o m GLS es ima ion by 4Dimensional XS ain STE and he a e age GLS was -17.22 %
(apical 2 chambe iew -17.21 %, apical 4 chambe iew -18.04 % and in apical long axis iew -16.42 %, espec i ely).
3.6. Glago ’s phenomenon o ascula emodeling
An impo an concep o ascula emodeling, e med Glago 's phenomenon, is ha a e ies emodel o main ain
cons an low despi e inc eases in a he oscle o ic lesion mass [38]. In 1987 Glago epo ed he su p ising inding ha
a he oscle o ic a e ial lumen na owing is no simply he esul o enla gemen o a he oscle o ic lesions. He and
se e al colleagues ound ins ead ha a e ies emodel o e a la ge ange o changes in wall mass, inc easing he ex e nal
diame e in a manne ha allows p ese a ion o he a e ial low. This abili y o a e ies o adap is cen al o mos
a e ial diseases (a he oscle o ic co ona y a e y disease, pe iphe al ascula disease and sys emic hype ension) [38]
(Figu es 17-19).
Figu e 17 Glago phenomenon: Hypo hesis o co ona y a e y emodeling
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Figu e 18 Scheme o ascula emodeling. A, No mal a e y. Whi e a ow poin s o physiological emodeling, black
a ow o pa hophysiological emodeling. B, P og ession o a he oscle osis causes lumen na owing when s enosis
exceeds 40%. C, Vascula inju y a e pe cu aneous ansluminal angioplas y (PTCA) causes cons ic i e emodeling
wi h dec eased essel size ( es enosis), whe eas p obucol ea men p omo ed ou wa d essel emodeling and
p e en ed lumen na owing (No es enosis: -0.2 mm in p obucol e sus -1.2 mm in placebo, a 6- old inhibi ion o
es enosis)
Figu e 19 Mul i-laye axisymme ic model o a e ial emodeling. Geome y in he (a) e e ence, uns essed
con igu a ion when <0, (b) p essu ized con igu a ion a = 0 and (c) g own, p essu ized con igu a ion o > 0; ,
ime
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3.7. Rela ion o calcium sco e wi h global longi udinal s ain
In a s udy o Venka a aman e al [39] ha e alua ed he ela ion o CAC wi h GLS in 159 asymp oma ic pa ien s
illus a ed ha he e was no signi ican di e ence be ween in mean GLS (19.2 s 19.5, P = .14), in hose wi hou o wi h
co ona y a e y calcium. Simila ly, ELSA - B asil s udy [40] demons a ed no co ela ion be ween absolu e CAC alues
and GLS. In he s udy, pa ien s we e classi ied acco ding o he p esence o co ona y calci ica ion (CAC >0 Aga s on
uni s) and in 3 CAC o dinal ca ego ies (0, 1 o 100, and >100 Aga s on uni s). GLS did no di e among hose wi h CAC
>0 when adjus ed o age and gende . These indings sugges ha subclinical dys unc ion e alua ed by GLS is no a
ma ked e ec o unde lying subclinical a he oscle osis.
High co ona y calcium sco e-challenges in in e p e a ion o co ona y CT angiog aphy
Technical pi alls and limi a ions o co ona y CT angiog aphy
Co ona y CT angiog aphy- challenges and limi a ion
The high nega i e-p edic i e alue o co ona y CT angiog aphy (CTA) makes i a sui able ool o excluding signi ican
co ona y a e y disease [41]. Co ona y CTA is echnically complex and places a g ea e emphasis on scanning
echnologies han any o he ype o CT examina ion. Indeed, co ona y a e ies bo h ha e small calib e and a ying
deg ees o mo ion du ing he ca diac cycle [41]. Image quali y can be deg aded by many pa ien - and echnique- ela ed
ac o s. Image a e ac s a e causes o misin e p e a ion, making he diagnos ic accu acy o co ona y CTA o a g ea
ex en dependen on hei ecogni ion and ope a o -awa eness [41]. Po en ial p oblems ela ed o hese a e ac s
include insu icien issue con as , limi ed spa ial and empo al esolu ion and inadequa e olume co e age.
The p incipal causes o a e ac s on co ona y CT angiog aphy a e ou lined on Table 6.
Table 6 Main co ona y CT angiog aphy a e ac s
A e ac s
P oblem
Cause
Blu ing
Mo ion
–HR > acquisi ion speed
–Respi a ion du ing acquisi ion
–Inapp op ia e ca diac cycle phase
econs uc ion
S ai s ep o
banding
–Mo ion
–Ca diac cycle phase mis egis a ion
–HR a ia ion
( achyca dia/a hy hmia)
–ECG signal ailu e
–Respi a ion du ing acquisi ion
S eak
Da k bands h ough objec s adjacen o high-a enua ion
s uc u es (beam-ha dening e ec )
–Me allic implan s, su gical clips
and co ona y s en s
–Vessel illed wi h high iodine
concen a ion
Blooming
High-a enua ion objec s appea la ge han hey a e
–Co ona y calci ica ions
–Me allic implan s, clips and
co ona y s en s
Windmill
Highly a enua ing s uc u es a e su ounded by low-
a enua ing ims, and low a enua ing s uc u es appea
la ge and ha e a “ an-like” appea ance
–Mo ing s uc u es du ing
acquisi ion
–HR > empo al esolu ion > spi al
acquisi ion pi ch
Low
a enua ing
Ai bubbles
–Ai wi hin he con as ma e ial
bolus
–Su ge y
ECG, elec oca diog am; HR, hea a e.
The main challenge in CTA is ha he e is a s ong demand o high empo al esolu ion, which ansla es in o he ime
equi ed o acqui e ca diac images in a e y sho pe iod. The empo al esolu ion is signi ican ly in e io o ha o
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in asi e co ona y angiog aphy. Hea a e con ol is necessa y o p oduce he bes images. Use o be a blocke s a e
necessa y in s udies pe o med wi h hese co ona y CTA [41].
Co ona y CT angiog aphy is unable o de e mine which plaques a e “ ulne able” o uns able om hose ha a e s able.
The e o e, di e en ia ion o lipid- ich con en om ib ous con en wi h mul islice CT emains challenging owing o
conside able o e lap in he a enua ion alues o lipid and ib ous issue. A he oscle o ic plaque and na u al
p og ession o he disease and may ha e an impo an clinical p edic i e alue. I is widely accep ed ha plaque
composi ion a he han he deg ee o luminal na owing may be p edic i e o he pa ien 's isk o ca diac e en s [41].
Wi h inc easing applica ion o CTA in he diagnosis o CAD, adia ion dose associa ed wi h co ona y CT angiog aphy has
aised se ious conce ns in he li e a u e, as he isk o de eloping malignancy is no negligible. The educ ion o
adia ion dose in CTA emains a con inuing challenge, and i is expec ed ha mo e esea ch will be conduc ed in ca diac
imaging wi h he use o mul islice CT [42].
A high Aga s on sco e is known o a ec he diagnos ic in o ma ion om CTA due o pa ial olume e ec s and beam
ha dening [43].
CTA disad an ages include educed image quali y in pa ien s wi h mo bid obesi y, dense calci ica ions, mul iple o
small-diame e s en s, ele a ed hea a es, o a hy hmia; he need o in a enous con as , which may be neph o oxic;
and he isk o excess downs eam es ing. CTA emains limi ed in spa ial and empo al esolu ion. O he es s a e
p e e able o pa ien s wi h mul iple s en s, ex ensi e calci ica ions, o lesions o unce ain hemodynamic signi icance
[44].
3.8. 2-Dimensional speckle acking echoca diog aphy-u ili y in CAD
GLS measu ed by 2-D STE a es has been ecognized as he mos sensi i e and ep oducible indica o o ischemia used
in he de ec ion o he significan CAD whe e egional wall mo ion abno mali y is o en no de ec ed by es ing
echoca diog aphy [45, 46]. 2DSTE can be used as a non-in asi e sc eening es in p edic ing p esence, ex en and
se e i y o signi ican CAD pa ien s wi h suspec ed s able angina pec o is [47]. On one hand mul iple au ho s ha e
epo ed [24-27] ha GLS alues a es ha e signi ican diagnos ic accu acy in p edic ing ex ensi e CAD. On he o he
hand se e al epo s ha e sugges ed o he wise.
Con e sely, in he s udy epo ed by Cauni e e al [48], le en icula sys olic unc ion assessed by global longi udinal
s ain had a s a is ically signi ican weak co ela ion wi h complexi y o co ona y a e y disease.
Se e al s udies ha e epo ed ha global longi udinal s ain measu ed by 2-D STE a es we e significan ly lowe in
pa ien s wi h ad anced CAD, as compa ed wi h pa ien s wi hou CAD [45-46].
Simila ly, ELSA - B asil s udy [49] demons a ed no co ela ion be ween absolu e CAC alues and GLS. In he s udy,
pa ien s we e classi ied acco ding o he p esence o co ona y calci ica ion (CAC >0 Aga s on uni s) and in 3 CAC o dinal
ca ego ies (0, 1 o 100, and >100 Aga s on uni s). GLS did no di e among hose wi h CAC >0 when adjus ed o age
and gende . These indings sugges ha subclinical dys unc ion e alua ed by GLS is no a ma ked e ec o unde lying
subclinical a he oscle osis.
4. Conclusion
Ou index pa ien , a heal hy asymp oma ic 65 yea old male, wi h a no mal 2D echoca diog aphy and TST, on a ou ine
co ona y CT angiog aphy was ound o ha e an ex ensi e h ee essel co ona y a e y disease accompanied by an
Aga s on calcium sco e o 468. He was sugges ed elsewhe e, o unde go ei he a mu li essel PCI wi h s en ing o CABG.
Howe e , due o mani old limi a ions and pi alls o CTA alongwi h knowledge o Glago ’s emodeling phenomenon, we
conduc ed a global longi udinal s ain echoca diog aphy by 4D XS ain speckle acking imaging and we e amazed o
ind a GLS alue o -17.2 % which is wi hin no mal ange. The p esence o no mal GLS alue ules ou he exis ence o
signi ican obs uc i e CAD.
Hence, acco dingly we ad ised a s a in and low dose aspi in o p e en ion o CAD and mo eo e , sugges ed o him o
unde go yea ly TST and GLS es ima ion o supe ising he p og ess o CAD, i any, in u u e.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 056-079
76
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o e hical app o al
The e hical app o al was ob ained om he Ins i u ional E hics Commi ee o P akash Hea S a ion, Ni alanaga ,
Lucknow.
S a emen o in o med consen
In o med consen was ob ained om he pa en s o ou index pa ien .
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