Reduced Peak Myocardial Work Efficiency With Coronary Flow Velocity Reserve Predicts Significant Coronary Artery Stenosis in Chronic Coronary Syndrome

Abstract

Background

Identification of significant coronary artery stenosis (CAS) in patients with chronic coronary syndromes (CCS) is crucial for clinical management. Myocardial work (MW) is a new noninvasive method reflecting myocardial metabolism and has been applied in myocardial ischemia. We aimed to explore the value of global MW during vasodilator stress echocardiography in detecting significant CAS.

Methods

Patients with angina or equivalent symptoms underwent coronary angiography and vasodilator stress echocardiography. Significant CAS was defined as ≥70% luminal stenosis in one or more major epicardial vessels or ≥50% in the left main coronary. Global MW was analyzed by speckle-tracking echocardiography with blood pressure. The diagnostic performance of MW parameters in detecting significant CAS was evaluated.

Results

One hundred forty-six patients were enrolled into the study, and 67 patients had significant CAS. Coronary flow velocity reserve (CFVR), global longitudinal strain (GLS), global MW index (MWI), and global MW efficiency (MWE) were significantly lower in the significant CAS group than those in the non-significant group both at rest and peak stress (p < 0.001 for CFVR, GLS, MWE; p < 0.01 for MWI). Logistic regression analyses showed that CFVR and peak MWE effectively predicted significant CAS. Peak MWE outperformed other parameters with the highest area under the curve (AUC) of 0.820. Furthermore, the model integrating CFVR and peak MWE (AUC = 0.886) was much better than CFVR or peak MWE alone.

Conclusions

Peak MWE combined with CVFR might be a reliable method of noninvasively screening significant CAS in patients with CCS before invasive angiography.