scholarly journals Comparison of Myocardial Layer-Specific Strain and Global Myocardial Work Efficiency During Treadmill Exercise Stress in Detecting Significant Coronary Artery Disease

2022 ◽  
Vol 8 ◽  
Author(s):  
Jingru Lin ◽  
Lijian Gao ◽  
Jia He ◽  
Mengyi Liu ◽  
Yuqi Cai ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Significant Coronary Artery Disease ◽  
Binary Logistic Regression ◽  
Diagnostic Value ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Non Invasive ◽  
Specific Strain ◽  
Artery Disease ◽  
Myocardial Layer

BackgroundMyocardial layer-specific strain can identify myocardial ischemia. Global myocardial work efficiency (GWE) based on non-invasive left ventricular (LV) pressure-strain loops is a novel parameter to determine LV function considering afterload. The study aimed to compare the diagnostic value of GWE and myocardial layer-specific strain during treadmill exercise stress testing to detect significant coronary artery disease (CAD) with normal baseline wall motion.MethodsEighty-nine patients who referred for coronary angiography due to suspected of CAD were included. Forty patients with severe coronary artery stenosis were diagnosed with significant CAD, and 49 were defined as non-significant CAD. Stress echocardiography was performed 24 h before angiography. Layer-specific longitudinal strains were assessed from the endocardium, mid-myocardium, and epicardium by 2D speckle-tracking echocardiography. Binary logistic regression analyses were performed to evaluate the association between significant CAD and echocardiographic parameters. A receiver operating characteristic curve was used to assess the capability of layer-specific strain and GWE to diagnose significant CAD.ResultsPatients with significant CAD had the worse function in all three myocardial layers at peak exercise compared with those with non-significant CAD when assessed with global longitudinal strain (GLS). At the peak exercise and recovery periods, GWE was lower in patients with significant CAD than in patients with non-significant CAD. In multivariable binary logistic regression analysis, peak endocardial GLS (OR: 1.35, p = 0.006) and peak GWE (OR: 0.76, p = 0.001) were associated with significant CAD. Receiver operating characteristic curves showed peak GWE to be superior to mid-myocardial, epicardial, and endocardial GLS in identifying significant CAD. Further, adding peak GWE to endocardial GLS could improve diagnostic capabilities.ConclusionsBoth GWE and endocardial GLS contribute to improving the diagnostic performance of exercise stress echocardiography. Furthermore, adding peak GWE to peak endocardial GLS provides incremental diagnostic value during a non-invasive screening of significant CAD before radioactive or invasive examinations.

Diagnostic value of longitudinal flow gradient for the presence of haemodynamically significant coronary artery disease

2018 ◽  
Vol 20 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Michiel J Bom ◽  
Roel S Driessen ◽  
Pieter G Raijmakers ◽  
Henk Everaars ◽  
Adriaan A Lammertsma ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Significant Coronary Artery Disease ◽  
Diagnostic Value ◽  
Longitudinal Flow ◽  
Flow Gradient ◽  
Artery Disease

scholarly journals The Influence of Endothelial Function and Myocardial Ischemia on Peak Oxygen Consumption in Patients with Coronary Artery Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Simon L. Bacon ◽  
Andrew Sherwood ◽  
Alan Hinderliter ◽  
Annik Plourde ◽  
Lee Pierson ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Oxygen Consumption ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Endothelial Function ◽  
Exercise Stress ◽  
Peak Oxygen Consumption ◽  
Peak Exercise ◽  
No Production ◽  
Artery Disease

Impaired endothelial function has been shown to limit exercise in coronary artery disease (CAD) patients and has been implicated in myocardial ischemia. However, the association of endothelial function and ischemia on peak exercise oxygen consumption (VO2) has not been previously reported. A total of 116 CAD patients underwent standard exercise stress testing, during which VO2was measured. On a separate day, endothelial-dependent and -independent function were assessed by ultrasound using flow-mediated arterial vasodilation (FMD) and sublingual glyceryl trinitrate administration (GTNMD) of the brachial artery. Patients with exercise-induced myocardial ischemia had lower FMD than nonischemic patients (3.64±0.57versus4.98±0.36,P=.050), but there was no difference in GTNMD (14.11±0.99versus15.47±0.63,P=.249). Analyses revealed that both FMD (P=.006) and GTNMD (P=.019) were related to peak VO2. However, neither the presence of ischemia (P=.860) nor the interaction of ischemia with FMD (P=.382) and GTNMD (P=.151) was related to peak VO2. These data suggest that poor endothelial function, potentially via impaired NO production and smooth muscle dysfunction, may be an important determinant of exercise capacity in patients with CAD, independent of myocardial ischemia.

scholarly journals Prediction of Significant Coronary Artery Disease Through Advanced Echocardiography: Role of Non-invasive Myocardial Work

2021 ◽  
Vol 8 ◽  
Author(s):  
Jolanda Sabatino ◽  
Salvatore De Rosa ◽  
Isabella Leo ◽  
Antonio Strangio ◽  
Carmen Spaccarotella ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Global Longitudinal Strain ◽  
Significant Coronary Artery Disease ◽  
Risk Area ◽  
Non Invasive ◽  
Work Index ◽  
Constructive Work ◽  
Invasive Method ◽  
Artery Disease

Background: Non-invasive prediction of critical coronary artery stenosis (CAST) in patients with coronary artery disease (CAD) is challenging. Strain parameters can often capture an impairment of regional longitudinal function; however, they are load dependent. A novel non-invasive method to estimate Myocardial Work (MW) has been recently proposed, showing a strong correlation with invasive work measurements. Our aim was to investigate the ability of non-invasive MW to predict the ischaemic risk area underlying a CAST.Methods and Results: The study population comprises 80 individuals: 50 patients with CAST and 30 controls (CTRL). Echocardiography recordings were obtained before coronary angiography to measure global longitudinal strain (GLS), Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial Work Efficiency (MWE). Global MWI (p = 0.048), MWE (p < 0.001), and MCW (p = 0.048) at baseline were significantly reduced in patients with CAST compared to controls (p < 0.05). Regional MWE within the myocardial segments underlying the CAST, but not LS, was significantly reduced compared to non-target segments (p < 0.001). At ROC analysis, the diagnostic performance to predict CAST for regional MWE (AUC = 0.920, p < 0.001) was higher compared to both regional post-systolic shortening index (PSI) (AUC = 0.600, p = 0.129) and regional LS (AUC = 0.546, p = 0.469).Conclusions: Non-invasive estimation of MW work indices is able to predict a CAST before invasive angiography.

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