Myocardial Work by Speckle Tracking Echocardiography Accurately Assesses Left Ventricular Function of Coronary Artery Disease Patients

Abstract

Objective: Myocardial work (MW) is a novel non-invasive method that uses speckle tracking echocardiography (STE) to assess left ventricular (LV) function. MW incorporates the global longitudinal strain and afterload conditions. Here we aimed to use MW to assess the LV function of patients with coronary artery disease (CAD) with or without heart failure (HF).Methods: We enrolled a total of 150 individuals (50 each) with CAD and a normal LV ejection fraction (LVEF), CAD with HF, and healthy controls. Patients were divided into the hypertension (HTN) and normal blood pressure (no HTN) subgroups. MW was determined from the pressure-strain loop using STE. The relationships between MW indices and conventional echocardiographic parameters were evaluated, and the MW indices were compared among groups.Results: Univariate and multivariate analyses showed that MW indices were strongly correlated with LVEF. The global work index (GWI) was increased in the CAD with normal LVEF subgroup with HTN vs. controls (1,922.3 ± 393.1 vs. 1,639.7 ± 204.6 mmHg%, p < 0.05) and decreased in CAD patients with HF (no HTN: 940.9 ± 380.6 vs. 1,639.7 ± 204.6 mmHg%, p < 0.05; HTN: 857.3 ± 369.3 vs. 1,639.7 ± 204.6 mmHg%, p < 0.05). Global waste work was increased in all CAD subgroups vs. controls. Global constructive work had the same tendency as GWI in patients with CAD. Global MW efficiency was decreased in all patients with CAD.Conclusion: MW using STE accurately quantifies LV function in patients with CAD. It offers additional information about LV function with respect to disease progression, particularly in CAD patients with a normal LVEF.

Association between left ventricular geometry and global myocardial work in patients with heart failure with preserved ejection fraction: assessment using strain-pressure loop

“…Besides, GMW indices showed a strong correlation with LVEF in our study and the measurements had a good consistency. These results are consistent with those of previous studies [28,29] .…”

Clinical research progress of myocardial work in assessment and prediction of coronary artery disease in noninvasive pressure‐strain loop technique

“…13,58,59 Changes in LVMW with exercise can also be an effective means of quantifying myocardial contractile reserve. 42 Resting GWE value is closely related to LV systolic reserve and exercise capacity, and GWE during exercise is an independent predictor of significant LV systolic reserve. 60 Therefore, PSL may also have an evaluation and prediction role in some diseases that can cause LV dysfunction, [61][62][63][64][65] especially in chronic kidney disease.…”

“…PSL has also played an important role not only in the field of cardiology, but also in dilated cardiomyopathy, 52,53 hypertrophic cardiomyopathy, 54,55 right ventricular cardiomyopathy, 56 hypertension, 52,57 and the evaluation of cardiac synchronization therapy 13,58,59 . Changes in LVMW with exercise can also be an effective means of quantifying myocardial contractile reserve 42 . Resting GWE value is closely related to LV systolic reserve and exercise capacity, and GWE during exercise is an independent predictor of significant LV systolic reserve 60 .…”

“…MW in these patients is reduced and can be used as an indicator for accurate quantification of LV function. 42 Studies have shown that LVGLS is significantly lower in patients with multi-vessel CAD, and LVGWI and LVGCW in patients with single-and multi-vessel CAD are significantly reduced. 43 In the prediction of high-risk stable coronary heart disease using MW parameters, GWI is better than LVEF, GWW, and GWE in predicting high-risk CAD 44 (Table 2).…”

“…In patients with obstructive epicardial CAD but without obvious segmental wall motion abnormalities and with normal LVEF, evaluation of LV function and recognition of CAD might be challenging. MW in these patients is reduced and can be used as an indicator for accurate quantification of LV function 42 . Studies have shown that LVGLS is significantly lower in patients with multi‐vessel CAD, and LVGWI and LVGCW in patients with single‐ and multi‐vessel CAD are significantly reduced 43 .…”