Global myocardial work in coronary artery disease patients without regional wall motion abnormality: Correlation with Gensini-score

Background: Early detection of coronary atherosclerotic diseases (CAD) without regional wall motion abnormality (RWMA) is important for improving the outcome of cardiovascular events. Global myocardial work (GMW), including global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global myocardial work efficiency (GWE), offer comprehensive quantitative assessment of myocardial function in CAD.Hypothesis: We hypothesized that GMW could provide incremental value in detecting CAD without RWMA.Methods: One hundred and twenty-four patients referred for coronary angiography (CAG) without resting RWMA were enrolled in this study. Global longitudinal strain (GLS), GWI, GCW, GWW, GWE were quantified. The severity of coronary lesions was evaluated by Gensini score (GS) based on CAG. We further divided CAG-confirmed CAD patients into three subgroups according to the tertiles of GS: low 0 < GS <= 17, mid 17 < GS <= 38, and high GS > 38.Results: Compared with control, CAD patients showed decreased GLS, GWE, GWI, GCW but an increased GWW. Compared to low-GS group, GWW was increased in the mid-GS group. GLS, GWE, GWI and GCW were decreased in the high-GS group while GWW was increased. Receiver operator characteristic curve analysis demonstrated that GWE was the most powerful predictor of high-GS and was superior to GLS. GWE under 92.0% had the optimal sensitivity and specificity for identifying high-GS.Conclusion: The proposed GWE, which outperformed the conventional GLS, could be considered as a potential predictive indicator to help to detect severe coronary disease in non-RWMA CAD patients.