Prediction of Significant Coronary Artery Disease Through Advanced Echocardiography: Role of Non-invasive Myocardial Work

Abstract

Background: Non-invasive prediction of critical coronary artery stenosis (CAST) in patients with coronary artery disease (CAD) is challenging. Strain parameters can often capture an impairment of regional longitudinal function; however, they are load dependent. A novel non-invasive method to estimate Myocardial Work (MW) has been recently proposed, showing a strong correlation with invasive work measurements. Our aim was to investigate the ability of non-invasive MW to predict the ischaemic risk area underlying a CAST.Methods and Results: The study population comprises 80 individuals: 50 patients with CAST and 30 controls (CTRL). Echocardiography recordings were obtained before coronary angiography to measure global longitudinal strain (GLS), Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial Work Efficiency (MWE). Global MWI (p = 0.048), MWE (p < 0.001), and MCW (p = 0.048) at baseline were significantly reduced in patients with CAST compared to controls (p < 0.05). Regional MWE within the myocardial segments underlying the CAST, but not LS, was significantly reduced compared to non-target segments (p < 0.001). At ROC analysis, the diagnostic performance to predict CAST for regional MWE (AUC = 0.920, p < 0.001) was higher compared to both regional post-systolic shortening index (PSI) (AUC = 0.600, p = 0.129) and regional LS (AUC = 0.546, p = 0.469).Conclusions: Non-invasive estimation of MW work indices is able to predict a CAST before invasive angiography.

Echocardiographic Myocardial Work: A Novel Method to Assess Left Ventricular Function in Patients with Coronary Artery Disease and Diabetes Mellitus

“…The low specificity underlines the fact that MW should be used along with other parameters to identify patients with significant CAD. Sabatino et al [24] further extended the previous results of Edwards et al's study and found that GWI, GCW and GWE were significantly reduced in patients with critical CAD (stenosis >70%) as compared to the controls. The novelty of this study was the assessment of the regionalized MW indices.…”

Non-Invasive Myocardial Work in Patients with Severe Aortic Stenosis

“…Timing of opening and closure of the valve were manually selected from 2D echo images. Global myocardial Work Index (GWI), Global myocardial Constructive Work (GCW), Global myocardial Wasted Work (GWW), and Global myocardial Work Efficiency (GWE) were calculated as previously described [4].…”

“…Left ventricular ejection fraction (LVEF) generally remains preserved despite initial deterioration of LV function. Global longitudinal strain (GLS) has been shown to be an earlier and more sensitive marker of LV dysfunction [3,4]. Nevertheless, its dependence from afterload represents a limitation in severe AS [5].…”

miR-146a-5p, miR-223-3p and miR-142-3p as Potential Predictors of Major Adverse Cardiac Events in Young Patients with Acute ST Elevation Myocardial Infarction—Added Value over Left Ventricular Myocardial Work Indices

“…Guo et al demonstrated that regional myocardial work measured by echocardiography exhibited a good diagnostic value in detecting significant myocardial ischaemia compared to the standard fractional flow reserve approach (measured invasively in the catheterisation laboratory) [ 58 ]. The use of regional GWE was able to identify at baseline CAD patients with critical coronary artery stenosis before invasive angiography with excellent performance (AUC = 0.92) in a trial from 2021 [ 59 ].…”