Qamruddin Salima, Fang Chen, Kachur Sergey, Bharwani Sahil, Elagizi Andrew, Stewart Merrill, Morin Daniel P, Smiseth Otto A, Gilliland Yvonne E
Division of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, New Orleans, LA, United States.
Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States.
Front Cardiovasc Med. 2025 Apr 8;12:1556991. doi: 10.3389/fcvm.2025.1556991. eCollection 2025.
Peak global myocardial work efficiency (GWE), a measure of peak global myocardial constructive to wasted work ratio, has been shown to discriminate coronary ischemia during treadmill stress echocardiography (SE). We wanted to assess additive utility of peak global longitudinal strain (GLS), global work index (GWI), and GWE in improving positive predictive value (PPV) of an abnormal dobutamine stress echocardiography (DSE) and calculate cost-savings by avoiding secondary tests.
We prospectively enrolled patients with abnormal DSE who underwent secondary confirmatory tests to confirm significant CAD as our primary cohort, and measured baseline and peak GLS, GWI, and GWE. We also included a control group with normal DSE results and similar measurements. The cost of secondary testing was used to calculate potential savings.
Among the 45 patients (71% females, mean age 60 ± 12 yrs.), 9 had significant CAD, 11 had non-significant CAD, and 25 were controls (N). Patients with significant CAD had significantly lower peak GLS [-15 (-17, -12.5) vs. -20 (-22, -19.5)%, < 0.001], peak GWI [1,057 (810.5, 1,057) vs. 2,245 (1,928.5, 2,961) mmHg%, = 0.02], peak GWE [82 (74.5, 86.5) vs. 89 [(86, 93.5)%, = 0.001], and peak GCW [1,618 (1,153.5, 2,003) vs. 2,585 (2,262.5, 3,262) mmHg%, = 0.02] compared to control. ROC analysis demonstrated peak GWE [AUC 0.76 (0.55, 0.97) = 0.01] to discriminate coronary ischemia. Incorporating peak GWE of <87% into abnormal DSE interpretation improved PPV from 45% to 81%, resulting in an estimated cost savings of $8,274.00 per screened patient.
Incorporating peak GWE into standard DSE interpretation enhanced diagnostic accuracy and reduced the cost of downstream testing.
全球心肌工作效率峰值（GWE）是衡量全球心肌建设性工作与浪费工作之比的指标，已证实在平板运动负荷超声心动图（SE）期间可鉴别冠状动脉缺血。我们旨在评估全球纵向应变峰值（GLS）、全球工作指数（GWI）和GWE在提高多巴酚丁胺负荷超声心动图（DSE）异常的阳性预测值（PPV）方面的附加效用，并通过避免二次检查来计算成本节约情况。
我们前瞻性纳入了DSE异常且接受二次确认检查以确诊显著冠状动脉疾病（CAD）的患者作为主要队列，并测量了基线及峰值GLS、GWI和GWE。我们还纳入了DSE结果正常且进行了类似测量的对照组。使用二次检查的成本来计算潜在节约情况。
在45例患者（71%为女性，平均年龄60±12岁）中，9例有显著CAD，11例有非显著CAD，25例为对照组（N）。与对照组相比，有显著CAD的患者峰值GLS更低[-15（-17，-12.5）%对-20（-22，-19.5）%，<0.001]，峰值GWI更低[1,057（810.5，1,057）mmHg%对2,245（1,928.5，2,961）mmHg%，=0.02]，峰值GWE更低[82（74.5，86.5）%对89[（86，93.5）%，=0.001]，峰值GCW更低[1,618（1,153.5，2,003）mmHg%对2,585（2,262.5，3,262）mmHg%，=0.02]。受试者工作特征（ROC）分析显示峰值GWE[AUC 0.76（0.55，0.97），=0.01]可鉴别冠状动脉缺血。将峰值GWE<87%纳入异常DSE解读可使PPV从45%提高至81%，估计每位筛查患者可节约成本8,274.00美元。
将峰值GWE纳入标准DSE解读可提高诊断准确性并降低下游检查成本。
