Exercise Electrocardiography and Speckle Tracking Assessment of Ischemia

Abstract

Ischemic heart disease remains a leading cause of morbidity and mortality worldwide, with many patients presenting with angina despite non-obstructive coronary artery disease. Conventional diagnostic tools such as exercise electrocardiography (ECG) provide functional assessment of ischemia but are sometimes limited in sensitivity and specificity, especially in populations with microvascular dysfunction or subtle myocardial injury. Speckle tracking echocardiography (STE), through the evaluation of global and regional longitudinal strain, offers an advanced imaging modality that detects subclinical myocardial dysfunction even when left ventricular ejection fraction is preserved. Combining the functional data from exercise ECG with the structural and mechanical insights from STE may enhance diagnostic accuracy, improve risk stratification, and provide a more comprehensive assessment of ischemia.