Clinical Investigations
Speckle Tracking Echocardiography for Coronary Artery Disease Detection
Global Myocardial Work Combined with Treadmill Exercise Stress to Detect Significant Coronary Artery Disease

https://doi.org/10.1016/j.echo.2021.10.009Get rights and content

Highlights

  • MW combined with exercise stress can help to identify significant CAD.

  • GWE is superior to GLS at peak exercise in detecting significant CAD.

  • GWW at the recovery period can identify significant CAD.

  • A new model comprising peak GWE and recovery GWW accurately detects significant CAD.

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.

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)

  • R. Winter et al.

    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

    (2007)
  • S. Shimoni et al.

    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

    (2011)
  • E. Galli et al.

    Value of myocardial work estimation in the prediction of response to cardiac resynchronization therapy

    J Am Soc Echocardiogr

    (2018)
  • N.F.A. Edwards et al.

    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

    (2019)
  • T. Takagi et al.

    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

    (2010)
  • A. Tsoukas et al.

    Significance of persistent left ventricular dysfunction during recovery after dobutamine stress echocardiography

    J Am Coll Cardiol

    (1997)
  • T. Dahlslett et al.

    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

    (2014)
  • F. von Scheidt et al.

    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

    (2020)
  • M.L. Geleijnse et al.

    Factors affecting sensitivity and specificity of diagnostic testing: dobutamine stress echocardiography

    J Am Soc Echocardiogr

    (2009)
  • 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.

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