Predictive value of myocardial performance indices for the detection of significant coronary artery disease in patients with a positive ischemia test

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Echocardiography using conventional global or segmental function evaluation has low diagnostic value in detecting subclinical coronary artery disease (CAD). Deformation parameters are more informative but load-dependent. Myocardial Work (MW) based on non-invasive LV pressure-strain loops has been suggested as a new alternative tool for the early detection of CAD. Purpose This study aimed to determine MW diagnostic performance in patients with a positive ischemia test. Methods Fifty-four patients referred for a coronary angiography secondary to a positive ischemia test were included (43 men (79.6%), mean age: 64.3 ± 9.7 years). Patients were divided into two groups according to the presence (SCAD) or absence (NCAD) of significant CAD requiring revascularization. Global and segmental MW parameters were measured on top of conventional echo parameters. Territorial myocardial work index (TWI) and constructive work (TCW) were analyzed according to coronary angiogram results. Results All patients had normal wall motion and left ventricular ejection fraction. There were no significant differences between the two groups regarding conventional echocardiographic parameters and global myocardial deformation. Patients with SCAD had a significantly reduced Global Constructive Work (GCW) compared to NCAD group (2316 mmHg% vs. 2565 mmHg%; p = 0.012). Territorial analysis confirmed a significant decrease in TCW in myocardial segments related to SCAD. GCW is the parameter with the largest AUC to predict a SCAD (AUC = 0.706; CI 95% (0.56 – 0.84)) with a high positive predictive value (73.9%). Conclusion Patients with SCAD had significantly impaired global and territorial MW parameters. MW quantification allows better discrimination of patients with confirmed SCAD. The routine addition of those parameters should improve the predictive value of ischemic tests.