Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.
School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
Echocardiography. 2021 Oct;38(10):1711-1721. doi: 10.1111/echo.15194. Epub 2021 Sep 12.
This study sought to determine the contractile reserve (CR) response to exercise stress echocardiography (ESE) quantified by the novel parameter, non-invasive myocardial work (MW), in subjects with angiographically proven coronary artery disease (CAD).
CR was measured by the relative change in ejection fraction (EF), global longitudinal strain (GLS) and MW indices from rest to peak exercise in 304 patients referred for clinically indicated ESE. Positive ESE patients proceeded to coronary angiography and further risk stratified based on either percutaneous or surgical intervention.
CR and global work index (CR ) significantly decreased with exercise induced ischemia and angiographically proven significant CAD (CR -1.6±3.5%; CR -8.6±511 mm Hg% decrement, p < 0.001) compared to non-ischemic patients (CR 1.4±2.2%; CR 398±404 mm Hg% improvement). Global constructive work (CR ) was significantly higher (p < 0.0001) in non-ischemic (818±457 mm Hg%) and blunted in ischemic patients (208±550 mm Hg%). CR (AUC .81; 95%CI:.75-.86) demonstrated the most association for inducible ischemia followed by CR (AUC .75; 95%CI:.69-.80), CR (AUC .73, 95%CI:.67-.79) and CR (AUC .71; 95%CI:.65-.77, p < 0.001). Subgroup analysis showed patients requiring surgical revascularization demonstrated a significantly lower CR (-11.5±7.6%, p < 0.05) as a result of reduced CR (281±573 mm Hg%, p < 0.05) and increased global wasted work (CR , 289±151 mm Hg%, p = 0.09).
Multivessel disease requiring surgical revascularization have the greatest reduction in CR. MW may potentially improve detection of ischemia and further risk stratification during ESE to maximize the benefits of revascularization.
本研究旨在通过新型参数无创心肌做功（MW）来确定经血管造影证实的冠心病（CAD）患者运动超声心动图（ESE）的收缩储备（CR）反应。
对 304 例因临床需要行 ESE 的患者，通过射血分数（EF）、整体纵向应变（GLS）和 MW 指数从休息到峰值运动的相对变化来测量 CR。阳性 ESE 患者行冠状动脉造影，并根据经皮或手术干预进一步进行危险分层。
与无缺血患者相比（CR 增加 1.4±2.2%；CR 增加 398±404mmHg%），有缺血诱导和经血管造影证实的严重 CAD（CR 减少 1.6±3.5%；CR 减少 8.6±511mmHg%）的患者，CR 和整体做功指数（CR ）显著降低（p<0.001）。无缺血患者的整体建设性工作（CR ）明显较高（p<0.0001）（818±457mmHg%），而缺血患者的则明显减弱（CR 208±550mmHg%）。CR（AUC.81；95%CI：.75-.86）对可诱导缺血的相关性最强，其次是 CR（AUC.75；95%CI：.69-.80）、CR（AUC.73，95%CI：.67-.79）和 CR（AUC.71；95%CI：.65-.77，p<0.001）。亚组分析显示，需要手术血运重建的患者的 CR 明显较低（-11.5±7.6%，p<0.05），这是由于 CR 减少（CR 281±573mmHg%，p<0.05）和整体浪费功增加（CR 289±151mmHg%，p=0.09）所致。
需要手术血运重建的多血管疾病患者的 CR 减少最大。MW 可能会提高 ESE 中缺血的检测能力，并进一步进行危险分层，以最大限度地提高血运重建的获益。
