Journal of cardiovascular medicine (Hagerstown, Md.) · 2026
Advances in stress echocardiography: myocardial work for myocardial ischemia detection.
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Cusmà-Piccione Maurizio, Licordari Roberto, Manganaro Roberta, Vizzari Giampiero, Lofrumento Francesca, Parisi Francesca, Trio Olimpia, De Gregorio Cesare, Ciampi Quirino, Carerj Scipione, Jain Renuka, Di Bella Gianluca, Micari Antonio, Zito Concetta
Аннотация
AIMS: This study explores the usefulness of myocardial work (MW) analysis for coronary artery disease (CAD) detection in patients undergoing dipyridamole stress echocardiography (Dip-SE).
METHODS: We included 50 patients subjected to Dip-SE followed by coronary computed tomography angiography (CCTA) and/or invasive coronary angiography (ICA). Patients were subdivided into two groups, according to the results of CCTA/ICA: group 1 with CAD and group 2 without CAD. Subsequently, global longitudinal strain (GLS) and MW parameters were evaluated retrospectively at base, low and high dose in the entire population.
RESULTS: GLS showed a nonsignificant increase from baseline to low dose and significantly decreased from low to high dose ( P = 0.015) in group 1. In contrast, GLS in group 2 increased throughout the test, with the largest increase from baseline to low dose ( P < 0.001). Global constructive work (GCW) and global wasted work (GWW) showed opposite behaviors in both groups: GCW decreased in group 1 ( P = 0.009) and remained substantially unchanged in group 2; conversely, GWW increased from low to high dose in group 1 ( P = 0.003), whereas it decreased in group 2 ( P = 0.047). The latter result was confirmed by global work efficiency (GWE), which decreased from low to high dose in group 1 ( P = 0.025) and increased in group 2 ( P = 0.001). Receiver-operating characteristics analysis revealed that GWE is the best parameter for identifying CAD (area under the curve = 0.845). A decrease in GWE of 1.5% (from low to high dose) provided better sensitivity (73%) and specificity (84%).
CONCLUSIONS: GWE analysis may be useful in improving CAD detection during Dip-SE.
METHODS: We included 50 patients subjected to Dip-SE followed by coronary computed tomography angiography (CCTA) and/or invasive coronary angiography (ICA). Patients were subdivided into two groups, according to the results of CCTA/ICA: group 1 with CAD and group 2 without CAD. Subsequently, global longitudinal strain (GLS) and MW parameters were evaluated retrospectively at base, low and high dose in the entire population.
RESULTS: GLS showed a nonsignificant increase from baseline to low dose and significantly decreased from low to high dose ( P = 0.015) in group 1. In contrast, GLS in group 2 increased throughout the test, with the largest increase from baseline to low dose ( P < 0.001). Global constructive work (GCW) and global wasted work (GWW) showed opposite behaviors in both groups: GCW decreased in group 1 ( P = 0.009) and remained substantially unchanged in group 2; conversely, GWW increased from low to high dose in group 1 ( P = 0.003), whereas it decreased in group 2 ( P = 0.047). The latter result was confirmed by global work efficiency (GWE), which decreased from low to high dose in group 1 ( P = 0.025) and increased in group 2 ( P = 0.001). Receiver-operating characteristics analysis revealed that GWE is the best parameter for identifying CAD (area under the curve = 0.845). A decrease in GWE of 1.5% (from low to high dose) provided better sensitivity (73%) and specificity (84%).
CONCLUSIONS: GWE analysis may be useful in improving CAD detection during Dip-SE.