Background: The integration of global longitudinal strain (GLS) with stress echocardiography (SE) represents a significant advancement in non-invasive cardiac diagnostics, particularly in the evaluation of coronary artery disease (CAD). GLS, derived from speckle-tracking echocardiography, quantifies myocardial deformation and offers superior sensitivity for detecting subclinical myocardial dysfunction compared to conventional metrics like wall motion and ejection fraction. Recent studies have validated the prognostic and diagnostic efficacy of GLS both at rest and during stress, notably enhancing the detection of obstructive and non-obstructive CAD, microvascular dysfunction, and other cardiac pathologies. Methods: This manuscript synthesizes extensive clinical data demonstrating the added value of GLS during stress echocardiography across diverse cardiac conditions—including valvular heart disease, heart failure, cardio-oncology, and pediatric cardiology. Novel metrics like longitudinal strain reserve (LSR), myocardial work indices, and post-systolic strain have further enriched risk stratification strategies. Results: The combination of GLS with SE has been shown to approximate the accuracy of invasive coronary angiography in intermediate-risk patients and in cases with equivocal traditional SE findings. Despite its clinical promise, the utility of GLS is challenged by technical limitations, including image quality dependency, inter-vendor variability, and limited applicability during high heart rate states. Conclusions: As technological refinement and standardization progress, GLS integrated with SE is poised to become a mainstay in precision cardiology, improving diagnostic yield, guiding therapeutic decisions, and enhancing patient outcomes.

Morning headaches (MHs) are a recognized but incompletely understood symptom in obstructive sleep apnea (OSA). Because symptoms and comorbidities that commonly coexist with OSA may influence both headache susceptibility and perceived sleep quality, the respective contributions of respiratory abnormalities and sleep disruption to MHs remain uncertain, particularly in women. We therefore aimed to identify clinical and sleep study factors associated with frequent MHs in patients with OSA. In this retrospective cohort study, 3227 adults with confirmed OSA evaluated between 2013 and 2023 were classified according to MH frequency (<1 episode/week vs. ≥1 episode/week). Demographic, clinical, questionnaire and sleep study variables were analyzed using univariate and multivariable logistic regression. Frequent MHs were reported by 35.2% of patients. On univariate analysis, MHs were associated with female sex, higher body mass index and waist circumference, greater OSA severity, worse nocturnal oxygenation, fatigue, excessive daytime sleepiness, and insomnia symptoms. However, in multivariable analysis restricted to patients with complete polysomnographic data (N = 501), female sex (OR 4.23, 95% CI 1.39–12.85), waist circumference (OR 1.03, 95% CI 1.01–1.06), and arousal index (OR 1.05, 95% CI 1.01–1.08) emerged as independent predictors, whereas conventional respiratory severity indices did not. These findings suggest that sleep fragmentation, rather than OSA severity alone, may be a key determinant of MHs, particularly in women, underscoring the need for sex-specific approaches beyond apnea–hypopnea index-based assessment.