Ran Hong, Yao Yujuan, Wan Linlin, Ren Junyi, Sheng Zongxiang, Zhang Pingyang, Schneider Matthias
Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Internal Medicine and Cardiology, Deutsches Herzzentrum der Charité Campus Virchow Klinikum Standort Mittelallee, Berlin, Germany.
Quant Imaging Med Surg. 2023 Aug 1;13(8):5022-5033. doi: 10.21037/qims-22-955. Epub 2023 Jun 19.
The novel echocardiographic parameter of myocardial work incorporates left ventricular pressure into the assessment of left ventricular systolic function and thereby corrects for afterload. We sought to investigate the diagnostic value of myocardial work to identify different grades of stenosis severity in coronary heart disease (CHD) patients with preserved left ventricular ejection fraction and without regional wall motion abnormalities.
One hundred and seventeen consecutive subjects with preserved ejection fraction referred for coronary angiography were randomized and prospectively included in this study. Forty-six in the control group, and 25, 24, and 22 in each of the grade-1, grade-2, and grade-3 CHD groups as classified by the Gensini score. The following indices of myocardial work were assessed with a Vivid E95 Version 203 instrument: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE).
Both GWI (P<0.001) and GCW (P<0.001) decreased significantly in CHD grade-1, increased slightly in CHD grade-2 compared with CHD grade-1, and decreased significantly in CHD grade-3. GWW (P<0.001) increased significantly from CHD grade-1 to CHD grade-3, while GWE (P<0.001) decreased significantly from CHD grade-1 to CHD grade-3. Receiver operating characteristic curves analysis revealed good discrimination between the control group and CHD grade-3 for GWI [area under the curve (AUC): 0.810; 95% confidence interval (CI): 0.691-0.930], GCW (AUC: 0.758; 95% CI: 0.631-0.885), GWW (AUC: 0.754; 95% CI: 0.624-0.885) and GWE (AUC: 0.817; 95% CI: 0.709-0.926). The assessment of intraobserver and interobserver variability in the MW echocardiographic data documented good interclass correlation coefficients (all >0.85).
Myocardial work incorporates left ventricular pressure into the assessment of left ventricular systolic function and thereby corrects for afterload. It identifies patients with incipient left ventricular dysfunction caused by chronic ischemia due to CHD. A gradual worsening of myocardial work parameters was observed when comparing patients with higher degrees of stenosis severity. Therefore, adding myocardial work when evaluating patients with suspected CHD may help increase diagnostic accuracy.
心肌做功这一新型超声心动图参数将左心室压力纳入左心室收缩功能评估，从而校正后负荷。我们旨在研究心肌做功对识别左心室射血分数保留且无节段性室壁运动异常的冠心病（CHD）患者不同程度狭窄严重性的诊断价值。
连续纳入117例射血分数保留且接受冠状动脉造影的受试者，随机并前瞻性地纳入本研究。对照组46例，根据Gensini评分分为1级、2级和3级CHD组，每组分别为25例、24例和22例。使用Vivid E95 Version 203仪器评估以下心肌做功指标：整体做功指数（GWI）、整体建设性做功（GCW）、整体无用功（GWW）、整体做功效率（GWE）。
与对照组相比，1级CHD组的GWI（P<0.001）和GCW（P<0.001）显著降低，2级CHD组相较于1级CHD组略有升高，3级CHD组显著降低。GWW从1级CHD组到3级CHD组显著增加（P<0.001），而GWE从1级CHD组到3级CHD组显著降低（P<0.001）。受试者工作特征曲线分析显示，GWI[曲线下面积（AUC）：0.810；95%置信区间（CI）：0.691-0.930]、GCW（AUC：0.758；95%CI：0.631-0.885）、GWW（AUC：0.754；95%CI：0.624-0.885）和GWE（AUC：0.817；95%CI：0.709-0.926）在对照组和3级CHD组之间具有良好的鉴别能力。心肌做功超声心动图数据的观察者内和观察者间变异性评估显示组内相关系数良好（均>0.85）。
心肌做功将左心室压力纳入左心室收缩功能评估，从而校正后负荷。它可识别由CHD慢性缺血导致的早期左心室功能障碍患者。比较狭窄严重程度较高的患者时，观察到心肌做功参数逐渐恶化。因此，在评估疑似CHD患者时增加心肌做功指标可能有助于提高诊断准确性。
