Journal of the American Society of Echocardiography
Focus Topic: Myocardial Work in Health and DiseaseClinical InvestigationNoninvasive Myocardial Work Index: Characterizing the Normal and Ischemic Response to Exercise
Graphical abstract
Section snippets
Methods
Patients were retrospectively enrolled from an existing database of exercise stress echocardiography across three regional institutions. Inclusion criteria were a clinical indication of possible ischemia and technical suitability to calculate myocardial work. Technical suitability included the absence of atrial fibrillation, aortic stenosis, or other significant valve disease or valve replacement, the availability of apical four-chamber, three-chamber, and two-chamber views, sufficient frame
Results
The database from 2015-19 identified 312 echocardiograms; 177 were included for further analysis. Criteria excluded 117 (51 high-risk subclinical cardiomyopathy, 43 abnormal baseline function, 22 inadequate image quality, 1 known cardiomyopathy). A total of 40 normal studies and 20 positive studies were identified for further analysis. Clinical characteristics are detailed in Table 1. No patients with normal stress echocardiography proceeded to an angiogram or had a new diagnosis of ischemia or
Discussion
This study characterizes the myocardial work and work efficiency response to exercise in patients with and without inducible ischemia. In normal conditions, myocardial work increases during exercise and efficiency remains unchanged. However, during exercise-induced ischemia, MWI paradoxically decreases in affected segments, while globally MWI fails to increase and efficiency decreases.
Our result of a 54% increase in myocardial work during exercise is consistent with previous invasive (48%
Conclusion
During normal exercise, myocardial work increases and efficiency remains unchanged. However, during exercise-induced ischemia, MWI paradoxically decreases in affected segments, while globally MWI fails to increase and efficiency decreases. Myocardial work is objective, quantitative, and load independent, and we demonstrate the feasibility of applying it to stress echocardiography to identify ischemia, but its utility remains uncertain. Further research with a larger prospective study making
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Cited by (20)
Myocardial work: The analytical methodology and clinical utilities
2022, Hellenic Journal of CardiologyCitation Excerpt :Edwards et al. reported MW indices were more sensitive to detect significant CAD (>70% stenosis) in patients with no visually regional wall motion abnormalities and preserved LVEF.29 In a study of exercise stress responses, Borrie et al. demonstrate the difference in MW indices between patients with and without inducible ischemia.30 During exercise stress, for patients with inducible ischemia, regional myocardial work index paradoxically decreased in affected segments, GWI had no obvious change, and GWE was significantly reduced, whereas GWI increased by 54% and efficiency was preserved in healthy controls.
Global Myocardial Work Combined with Treadmill Exercise Stress to Detect Significant Coronary Artery Disease
2022, Journal of the American Society of EchocardiographyCitation Excerpt :Particularly, peak GWE and peak GWW had a relatively high diagnostic value for significant CAD patients. In another recent study, Borrie et al.12 revealed that GWI and GWE could characterize the normal and ischemic responses to exercise. Their study finally included 40 normal subjects and 20 patients with positive stress echocardiography results, and the sample size was smaller than that of our study.
The Utility of Myocardial Work in Clinical Practice
2021, Journal of the American Society of EchocardiographyCitation Excerpt :Several studies have been performed on MW and stress echocardiography. Borrie et al.27 investigated the normal response to exercise and sought to identify patients with inducible ischemia with MW. The group determined that during normal exercise, GWI increases and GWE is unchanged.
Association between myocardial work indices and cardiovascular events according to hypertension in the general population
2024, European Heart Journal Cardiovascular ImagingGlobal and regional myocardial function assessment in symptomatic patients with chronic coronary syndrome using longitudinal strain and noninvasive myocardial work
2023, International Journal of Cardiovascular Imaging
Conflicts of Interest: None.