Clinical InvestigationsSpeckle Tracking Echocardiography for Coronary Artery Disease DetectionGlobal Myocardial Work Combined with Treadmill Exercise Stress to Detect Significant Coronary Artery Disease
Section snippets
Study Population
This study included 85 patients with angina pectoris and other evidence of myocardial ischemia or coronary artery stenosis who were ready to undergo coronary angiography (CAG) after stress echocardiography examination. Other inclusion criteria were the availability of the apical four-chamber, three-chamber, and two-chamber views, sufficient frame rate to allow strain calculation (>50 frames per second), and the availability of blood pressure measurements at rest and postexercise. Exclusion
Characteristics of the Study Population
Eighty-five patients were finally included in this study. Twenty-five patients had a positive exercise echocardiogram, while significant coronary artery stenosis was observed in 41 patients and the remaining 44 patients were classified into the nonsignificant CAD group. Characteristics of the study population, including demographics, clinical characteristics, angiographic results, exercise stress data, and hemodynamic responses to exercise, are summarized in Table 1. No differences were
Discussion
In this study, we demonstrated the diagnostic potential of global MW parameters combined with treadmill exercise for identification of significant CAD in patients with angina pectoris. Peak GWE was the best single parameter to detect significant CAD among LVEF, WMSI, and other MW parameters, followed by peak GWW and recovery GWW. Furthermore, our study discovered a new model comprising peak GWE and recovery GWW that shows better diagnostic value in identifying significant CAD than peak GWE
Conclusion
Peak GWE could detect significant CAD in patients with angina pectoris, being superior to conventional stress echocardiography. Furthermore, the new model, comprising peak GWE and recovery GWW, not only showed a great diagnostic potential to identify significant CAD but also provided additional value for estimating the probability of significant CAD. Global MW parameters combined with exercise stress may complement existing diagnostic algorithms and act as an accurate noninvasive screening
Acknowledgments
We thank the staff of the Functional Testing Center and the Department of Cardiology of Fuwai Hospital for their invaluable assistance in this research. We would like to thank Editage (www.editage.cn) for English language editing.
References (39)
- et al.
Comparison of visual assessment of coronary stenosis with independent quantitative coronary angiography: findings from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial
Am Heart J
(2017) - et al.
Head-to-head comparison of peak supine bicycle exercise echocardiography and treadmill exercise echocardiography at peak and at post-exercise for the detection of coronary artery disease
J Am Soc Echocardiogr
(2012) - et al.
Normal ranges of left ventricular strain: a meta-analysis
J Am Soc Echocardiogr
(2013) - et al.
Left ventricular pressure-strain-derived myocardial work at rest and during exercise in patients with cardiac amyloidosis
J Am Soc Echocardiogr
(2020) - et al.
Measurement of global myocardial work with exercise testing
J Am Soc Echocardiogr
(2020) - et al.
Noninvasive myocardial work index: characterizing the normal and ischemic response to exercise
J Am Soc Echocardiogr
(2020) - et al.
The utility of myocardial work in clinical practice
J Am Soc Echocardiogr
(2021) - et al.
Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography
J Am Soc Echocardiogr
(2019) - et al.
Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography
J Am Soc Echocardiogr
(2020) - et al.
ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography
J Am Coll Cardiol
(2012)
Speckle tracking echocardiography is a sensitive tool for the detection of myocardial ischemia: a pilot study from the catheterization laboratory during percutaneous coronary intervention
J Am Soc Echocardiogr
Differential effects of coronary artery stenosis on myocardial function: the value of myocardial strain analysis for the detection of coronary artery disease
J Am Soc Echocardiogr
Value of myocardial work estimation in the prediction of response to cardiac resynchronization therapy
J Am Soc Echocardiogr
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
J Am Soc Echocardiogr
Detection of coronary artery disease using delayed strain imaging at 5 min after the termination of exercise stress: head to head comparison with conventional treadmill stress echocardiography
J Cardiol
Significance of persistent left ventricular dysfunction during recovery after dobutamine stress echocardiography
J Am Coll Cardiol
Early assessment of strain echocardiography can accurately exclude significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary syndrome
J Am Soc Echocardiogr
Left ventricular strain and strain rate during submaximal semisupine bicycle exercise stress echocardiography in healthy adolescents and young adults: systematic protocol and reference values
J Am Soc Echocardiogr
Factors affecting sensitivity and specificity of diagnostic testing: dobutamine stress echocardiography
J Am Soc Echocardiogr
Cited by (0)
The first two authors should be considered similar in author order.
This work was supported by the Beijing Municipal Science and Technology Commission (grant no. Z171100001017213) and Construction Research Project of Key Laboratory (Cultivation) of Chinese Academy of Medical Sciences (grant no. 2019PT310025).
Conflicts of Interest: None.