Diagnostic Value of Global and Regional Myocardial Work in Coronary Artery Disease with Normal Ejection Fraction and Wall Motion

Abstract Background: The potential of global and regional myocardial work (MW) parameters for detecting moderate, clinically unapparent coronary artery disease (CAD) remains unclear. This study aimed to evaluate the diagnostic power of global and regional MW to detect CAD in patients with normal left ventricular ejection fraction and wall motion. Methods: One hundred and seventy-six consecutive patients with clinically suspected CAD were prospectively included. All subjects underwent comprehensive echocardiographic evaluation and coronary angiography. Noninvasive MW indices include global work index (GWI), global work efficiency (GWE), global constructive work (GCW), global wasted work (GWW) and regional MW parameters. Results: GWI, GWE and GCW were significantly impaired in patients with CAD (stenosis ≥50%) compared with patients without CAD (all P＜0.01). An optimal GWI cutoff value of 1855.5 mmHg % (sensitivity, 71.7%; specificity, 78.0%) has been defined for predicting CAD [area under the curve (AUC) value, 0.76; P = 0.000]. GWI provided incremental value over all other echocardiographic parameters in detecting CAD, including global longitudinal strain (GLS) (P＜0.05). MW parameters in left anterior descending (LAD) segments had higher diagnostic value (AUC = 0.67-0.74, all P = 0.000) than parameters in left circumflex (LCX) (AUC = 0.64, P＜0.01) or right coronary artery (RCA) territories (AUC = 0.65-0.71, all P＜0.01).Conclusions: Global and regional MW parameters assessed at rest are of good diagnostic value for detecting CAD. GWI provides incremental value over all other echocardiographic parameters in predicting CAD, including GLS. Besides, regional MW may be a useful tool to localize and detect relevant coronary artery stenosis.