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Purpose: Ischemic myocardium with reduced active force will lengthen when left ventricular (LV) pressure is rising during early systole before onset of systolic shortening. The object of this study was to investigate whether the duration of LV systolic lengthening measured by two dimensional speckle tracking echocardiography (2D-STE) at rest could accurately identify patients with significant coronary artery disease (CAD).Methods: We included 65 patients with suspected CAD referred to an elective diagnostic coronary angiography. None of these patients had a previous history of overt myocardial infarction. 2D-STE was performed before angiography. Global longitudinal strain and duration of LV systolic lengthening were recorded in 3 apical long-axis recordings and averaged from 16 LV segments (Figure).Results: Of the 65 patients, there were 26 with significant CAD defined as ≥50% diameter stenosis in any coronary artery. The duration of systolic lengthening was significantly prolonged in patients with CAD as compared with patients without significant coronary artery stenoses (84±41ms vs. 38±24ms, P<0.001). Correspondingly, global systolic longitudinal strain was significantly lower in patients with CAD (-17.7±3.2% vs. -19.6±2.6%, P=0.01).Conclusions: Duration of myocardial systolic lengthening was prolonged in patients with significant coronary artery stenoses and might be a useful tool to identify these patients. Our results indicate that patients with significant CAD have myocardial segments with reduced active force also at rest.