Parlavecchio Antonio, Vetta Giampaolo, Caminiti Rodolfo, Ajello Manuela, Magnocavallo Michele, Vetta Francesco, Foti Rosario, Crea Pasquale, Micari Antonio, Carerj Scipione, Della Rocca Domenico Giovanni, Di Bella Gianluca, Zito Concetta
Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy.
Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, Rome, Italy.
Echocardiography. 2023 Mar;40(3):217-226. doi: 10.1111/echo.15537. Epub 2023 Feb 7.
Early diagnosis of Coronary Artery Disease (CAD) plays a key role to prevent adverse cardiac events such as myocardial infarction and Left Ventricular (LV) dysfunction. Myocardial Work (MW) indices derived from echocardiographic speckle tracking data in combination with non-invasive blood pressure recordings seems promising to predict CAD even in the absence of impairments of standard echocardiographic parameters. Our aim was to compare the diagnostic accuracy of MW indices to predict CAD and to assess intra- and inter-observer variability of MW through a meta-analysis.
Electronic databases were searched for observational studies evaluating the MW indices diagnostic accuracy for predicting CAD and intra- and inter-observer variability of MW indices. Pooled sensitivity, specificity, and Summary Receiver Operating Characteristic (SROC) curves were assessed.
Five studies enrolling 501 patients met inclusion criteria. Global Constructive Work (GCW) had the best pooled sensitivity (89%) followed by GLS (84%), Global Work Index (GWI) (82%), Global Work Efficiency (GWE) (80%), and Global Wasted Work (GWW) (75%). GWE had the best pooled specificity (78%) followed by GWI (75%), GCW (70%), GLS (68%), and GWW (61%). GCW had the best accuracy according to SROC curves, with an area under the curve of 0.86 compared to 0.84 for GWI, 0.83 for GWE, 0.79 for GLS, and 0.74 for GWW. All MW indices had an excellent intra- and inter-observer variability.
GCW is the best MW index proving best diagnostic accuracy in the prediction of CAD with an excellent reproducibility.
冠状动脉疾病（CAD）的早期诊断对于预防心肌梗死和左心室（LV）功能障碍等不良心脏事件起着关键作用。从超声心动图斑点追踪数据结合无创血压记录得出的心肌做功（MW）指标，似乎有望预测CAD，即使在标准超声心动图参数无损害的情况下也是如此。我们的目的是通过荟萃分析比较MW指标预测CAD的诊断准确性，并评估MW指标在观察者内和观察者间的变异性。
检索电子数据库，以查找评估MW指标预测CAD的诊断准确性以及MW指标在观察者内和观察者间变异性的观察性研究。评估合并敏感性、特异性和汇总接收器操作特征（SROC）曲线。
五项纳入501例患者的研究符合纳入标准。整体建设性做功（GCW）的合并敏感性最佳（89%），其次是GLS（84%）、整体做功指数（GWI）（82%）、整体做功效率（GWE）（80%）和整体无用功（GWW）（75%）。GWE的合并特异性最佳（78%），其次是GWI（75%）、GCW（70%）、GLS（68%）和GWW（61%）。根据SROC曲线，GCW的准确性最佳，曲线下面积为0.86，而GWI为0.84，GWE为0.83，GLS为0.79，GWW为0.74。所有MW指标在观察者内和观察者间均具有出色的变异性。
GCW是最佳的MW指标，在预测CAD方面具有最佳的诊断准确性和出色的可重复性。
