Performance of the left ventricular myocardium in patients with a negative test result during exercise stress echocardiography

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Abstract

Aim. To determine the possibility of identifying patients with significant coronary artery disease (CAD) by evaluation of the left ventricular (LV) myocardial work indicators by constructing pressure-strain loops despite a negative test result during exercise stress echocardiography.

Materials and methods. The study included 79 patients with suspected or previously confirmed CAD, of which 47 (59%) men, who had a negative test result during exercise stress echocardiography on the treadmill. Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were evaluated using the technique of constructing pressure-strain loops at rest and at peak exercise.

Results. With similar systolic blood pressure and LV ejection fraction at peak exercise between the control group and the group of patients with single-vessel CAD, there was revealed significant difference in GWI, GCW and GWE at peak exercise. In patients with multi-vessel CAD, GWI and GCW also significantly differed from the control group at peak exercise.

Conclusion. The evaluation of LV myocardial work indicators may be recommended for a more accurate diagnosis of CAD in negative or unreliable test results during exercise stress echocardiography.

About the authors

Mikhail N. Alekhin

Central State Medical Academy of the President of the Russian Federation; Central Clinical Hospital with Clinic of the President of the Russian Federation

Author for correspondence.
Email: mike.nikolaich@yandex.ru
ORCID iD: 0000-0002-9725-7528

д-р мед. наук, проф. каф. терапии, кардиологии и функциональной диагностики с курсом нефрологии, зав. отд-нием функциональной диагностики

Russian Federation, Moscow; Moscow

Natalya F. Radova

Central State Medical Academy of the President of the Russian Federation; Central Clinical Hospital with Clinic of the President of the Russian Federation

Email: mike.nikolaich@yandex.ru
ORCID iD: 0000-0001-8085-3166

канд. мед. наук, доц. каф. терапии, кардиологии и функциональной диагностики с курсом нефрологии, врач отд-ния функциональной диагностики

Russian Federation, Moscow; Moscow

Svetlana P. Leshchinskaia

Russian University of Medicine

Email: mike.nikolaich@yandex.ru
ORCID iD: 0009-0004-4482-990X

студентка

Russian Federation, Moscow

Sergey I. Ivanov

Clinical Hospital of the President of the Russian Federation

Email: mike.nikolaich@yandex.ru
ORCID iD: 0000-0002-6768-1045

канд. мед. наук, врач отд-ния кардиологии

Russian Federation, Moscow

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2. Fig. 1.ROC curves showing the capabilities of the left ventricular ejection fraction (a), global longitudinal systolic deformation (b), left ventricular GWI myocardial index (c), global constructive work (GCW) (d) at the maximum load in identifying patients with a negative test result and significant coronary artery lesion.

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3. Fig. 2. An example of assessment of the left ventricular myocardium performance at rest and at the maximum load in a 68-year-old patient with a negative test result during an exercise stress-EchoCG. Coronary angiography showed stenosis of 85% at the border of the anterior and middle third of the anterior interventricular branch, stenosis of 70% at the ostium of the diagonal branch (small diameter artery), stenosis of 80% in the middle third of the right coronary artery.

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