Global Myocardial Work Is Superior to Global Longitudinal Strain to Predict Significant Coronary Artery Disease in Patients With Normal Left Ventricular Function and Wall Motion

Abstract

Background: Noninvasive detection of functionally significant coronary artery disease (CAD) by echocardiography remains challenging, with the need to perform stress imaging to detect ischemia. The aim of this study was to determine whether global myocardial work (MW), derived from noninvasive left ventricular (LV) pressure-strain loops at rest, can predict significant CAD in patients without regional wall motion abnormalities and preserved LV ejection fraction (EF). Methods: One hundred and fifteen patients referred for coronary angiography who had EF $ 55%, no resting regional wall motion abnormalities, and no chest pain were assessed using echocardiography. Global MW was derived from noninvasive LV pressure-strain loops constructed from speckle-tracking echocardiography indexed to brachial systolic blood pressure. Global constructive work represented the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation. Global wasted work represented energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation. Global MW efficiency was derived from the percentage ratio of constructive work to the sum of constructive work and wasted work. Results: Patients with significant CAD demonstrated a significantly reduced global MW (P < .001) compared with those without CAD. Global longitudinal strain was significantly reduced (P < .001) in patients with multivessel CAD but not those with single-vessel CAD (P = .47). Receiver operating characteristic curve analysis demonstrated that global MW was the most powerful predictor of significant CAD (area under the curve = 0.786) and was superior to global longitudinal strain (area under the curve = 0.693). The optimal cutoff global MW value to predict significant CAD was 1,810 mm Hg% (sensitivity, 92%; specificity, 51%). Conclusions: Noninvasive global MW derived using LV pressure-strain loops at rest is a more sensitive index than global longitudinal strain to detect significant CAD in patients with no regional wall motion abnormalities and normal EF. This is a potential valuable clinical tool to assist in the early diagnosis of CAD.

Value of quantitative analysis of left ventricular systolic function in patients on maintenance hemodialysis based on myocardial work technique

“…Our further analysis of the GLS and MW parameters for LVH patients revealed that the AUCs of GWE, GWW, and GLS were signi cantly higher than that of GWI and GCW. This observation was different from that in a previous study [40], in which the AUCs of GWI and GCW in CHD patients were higher than those of GLS, GWE, and GWW. This discrepancy may be explained by the different mechanisms underlying CHD and LVH in MHD patients.…”

“…On the other hand, we found that the AUCs of GWE and GWW were higher than that of GLS. In addition, one of the main limitations of GLS is its load-dependence, and the increase in afterload can reduce the wall tension, leading to a misinterpretation of the true contractile function of the myocardium [40,44]. However, for MW measurement, the non-invasive PSL integrates the afterload into the LV strain parameters, and thus MW is an optimization of the strain values [45].…”

Can myocardial work indices contribute to the exploration of patients with cardiac amyloidosis?

“…[8][9][10][11] However, the GLS depends on the load, which may lead to a misinterpretation of the contractile function of the myocardium. [12][13][14] Thus, myocardial work (MW) is emerging as an alternative tool for studying LV myocardial systolic function incorporating deformation and afterload into its analysis. 15 Non-invasive MW is based on LV pressure-strain loop, which explores LV function balanced by afterload with an estimation of intraventricular pressure during a cardiac cycle 13 and can be easily calculated at the time of TTE examination using commercial software.…”

“…The median follow-up duration was 11 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] months. Among the whole population, 28 (24%) died including 8 (31%) with AL-CA, 18 (23%) with wild-type ATTR and 2 (17%) variant-type ATTR.…”

Assessment of left ventricular systolic function by non-invasive pressure-strain loop area in young male strength athletes

“…Signi cantly, increased PSD in the athlete group draw attention to the points that the systolic synchronization of LV had been destroyed and nonuniformity of ventricular wall motion would reduce the mechanical e ciency during cardiac ejection. 14 In addition, the strength athletes were characterized by high LV afterload which would lead to the increased of LV stiffness. Eventually, result in more energy loss expressed as increased GWW and reduced GWE.…”