Background

Myocardial work (MW) derived from the left ventricular pressure-strain loop is a novel and noninvasive method for assessing left ventricular function that accounts for loading conditions. We aimed to explore whether global MW combined with treadmill exercise stress could detect significant coronary artery disease (CAD) in patients with angina pectoris.

Methods

Eighty-five patients with angina pectoris and no prior CAD history were included. All patients underwent treadmill exercise stress echocardiography and coronary angiography. Global MW was constructed from speckle-tracking echocardiography indexed to the brachial systolic blood pressure. The association between MW parameters and the presence of significant CAD was assessed with logistic regression. The discriminative power of MW parameters to detect CAD was assessed with receiver operative characteristic curve, net reclassification improvement, and integrated discrimination improvement analysis.

Results

Twenty-five patients had a positive exercise echocardiogram, while significant coronary artery stenosis (≥70% in one or more major epicardial vessels or ≥50% in the left main coronary artery) was observed in 41 patients. The global wasted work (GWW) and global work efficiency (GWE) were significantly higher or lower, respectively, in patients with significant CAD compared with those of nonsignificant CAD at the peak exercise and during recovery periods (P < .05 for all). Multivariate logistic regression analysis demonstrated that peak GWE and recovery GWW could predict significant CAD. Peak GWE had the highest area under the receiver operating characteristic curve (AUC) among all global MW parameters (AUC = 0.836). Furthermore, a model comprising peak GWE and recovery GWW performed better for the identification of significant CAD than peak GWE alone (AUC = 0.856).

Conclusions

Peak GWE could detect significant CAD. The new model, incorporating peak GWE and recovery GWW, not only identified but also provided additional value for estimating the probability of significant CAD. Global MW parameters combined with exercise stress perform as an accurate noninvasive screening before the invasive diagnostic technique.

中文翻译：

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全球心肌工作结合跑步机运动压力检测显着冠状动脉疾病

背景

源自左心室压力-应变环的心肌功 (MW) 是一种新颖的非侵入性方法，用于评估考虑负荷条件的左心室功能。我们旨在探讨全球 MW 结合跑步机运动压力是否可以检测心绞痛患者的显着冠状动脉疾病 (CAD)。

方法

包括 85 名心绞痛患者且无 CAD 病史。所有患者均接受了跑步机运动负荷超声心动图和冠状动脉造影。Global MW 是由散斑追踪超声心动图构建的，该超声心动图以肱动脉收缩压为索引。使用逻辑回归评估 MW 参数与是否存在显着 CAD 之间的关联。MW 参数检测 CAD 的鉴别能力通过接受者操作特征曲线、净重分类改进和综合鉴别改进分析进行评估。

结果

25 名患者的运动超声心动图呈阳性，而在 41 名患者中观察到明显的冠状动脉狭窄（一个或多个主要心外膜血管≥70% 或左冠状动脉主干≥50%）。与非显着 CAD 患者相比，显着 CAD 患者在运动高峰期和恢复期的总体浪费功（GWW）和总体工作效率（GWE）分别显着升高或降低（P < .05 全部）。多变量逻辑回归分析表明峰值 GWE 和恢复 GWW 可以预测显着 CAD。在所有全球 MW 参数中，峰值 GWE 的接收者操作特征曲线 (AUC) 下面积最高 (AUC = 0.836)。此外，包含峰值 GWE 和恢复 GWW 的模型在识别显着 CAD 方面比单独的峰值 GWE 表现更好（AUC = 0.856）。

结论

Peak GWE 可以检测到显着的 CAD。新模型结合了峰值 GWE 和恢复 GWW，不仅识别而且为估计显着 CAD 的概率提供了额外的价值。全球 MW 参数与运动压力相结合，可作为侵入性诊断技术之前的准确无创筛查。