Peak myocardial work assessment to detect coronary ischemia during dobutamine stress echocardiography
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 w...
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| Published in | Frontiers in cardiovascular medicine Vol. 12; p. 1556991 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
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Frontiers Media S.A
08.04.2025
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| ISSN | 2297-055X 2297-055X |
| DOI | 10.3389/fcvm.2025.1556991 |
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| Abstract | 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. |
|---|---|
| AbstractList | 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.IntroductionPeak 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.MethodsWe 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)%, p < 0.001], peak GWI [1,057 (810.5, 1,057) vs. 2,245 (1,928.5, 2,961) mmHg%, p = 0.02], peak GWE [82 (74.5, 86.5) vs. 89 [(86, 93.5)%, p = 0.001], and peak GCW [1,618 (1,153.5, 2,003) vs. 2,585 (2,262.5, 3,262) mmHg%, p = 0.02] compared to control. ROC analysis demonstrated peak GWE [AUC 0.76 (0.55, 0.97) p = 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.ResultsAmong 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)%, p < 0.001], peak GWI [1,057 (810.5, 1,057) vs. 2,245 (1,928.5, 2,961) mmHg%, p = 0.02], peak GWE [82 (74.5, 86.5) vs. 89 [(86, 93.5)%, p = 0.001], and peak GCW [1,618 (1,153.5, 2,003) vs. 2,585 (2,262.5, 3,262) mmHg%, p = 0.02] compared to control. ROC analysis demonstrated peak GWE [AUC 0.76 (0.55, 0.97) p = 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.ConclusionsIncorporating peak GWE into standard DSE interpretation enhanced diagnostic accuracy and reduced the cost of downstream testing. 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. IntroductionPeak 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.MethodsWe 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.ResultsAmong 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)%, p < 0.001], peak GWI [1,057 (810.5, 1,057) vs. 2,245 (1,928.5, 2,961) mmHg%, p = 0.02], peak GWE [82 (74.5, 86.5) vs. 89 [(86, 93.5)%, p = 0.001], and peak GCW [1,618 (1,153.5, 2,003) vs. 2,585 (2,262.5, 3,262) mmHg%, p = 0.02] compared to control. ROC analysis demonstrated peak GWE [AUC 0.76 (0.55, 0.97) p = 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.ConclusionsIncorporating peak GWE into standard DSE interpretation enhanced diagnostic accuracy and reduced the cost of downstream testing. |
| Author | Kachur, Sergey Smiseth, Otto A. Gilliland, Yvonne E. Stewart, Merrill Bharwani, Sahil Qamruddin, Salima Morin, Daniel P. Fang, Chen Elagizi, Andrew |
| AuthorAffiliation | 3 Echocardiography Laboratory, Ochsner Medical Center , New Orleans, LA , United States 4 Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo , Oslo , Norway 2 Ochsner Clinical School, The University of Queensland School of Medicine , New Orleans, LA , United States 1 Division of Cardiovascular Disease, John Ochsner Heart and Vascular Institute , New Orleans, LA , United States |
| AuthorAffiliation_xml | – name: 1 Division of Cardiovascular Disease, John Ochsner Heart and Vascular Institute , New Orleans, LA , United States – name: 4 Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo , Oslo , Norway – name: 2 Ochsner Clinical School, The University of Queensland School of Medicine , New Orleans, LA , United States – name: 3 Echocardiography Laboratory, Ochsner Medical Center , New Orleans, LA , United States |
| Author_xml | – sequence: 1 givenname: Salima surname: Qamruddin fullname: Qamruddin, Salima – sequence: 2 givenname: Chen surname: Fang fullname: Fang, Chen – sequence: 3 givenname: Sergey surname: Kachur fullname: Kachur, Sergey – sequence: 4 givenname: Sahil surname: Bharwani fullname: Bharwani, Sahil – sequence: 5 givenname: Andrew surname: Elagizi fullname: Elagizi, Andrew – sequence: 6 givenname: Merrill surname: Stewart fullname: Stewart, Merrill – sequence: 7 givenname: Daniel P. surname: Morin fullname: Morin, Daniel P. – sequence: 8 givenname: Otto A. surname: Smiseth fullname: Smiseth, Otto A. – sequence: 9 givenname: Yvonne E. surname: Gilliland fullname: Gilliland, Yvonne E. |
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| Cites_doi | 10.1016/j.echo.2020.01.021 10.1093/ehjci/jey156 10.1016/j.echo.2009.10.004 10.1016/j.echo.2009.11.023 10.1093/eurheartj/ehm188 10.1161/CIRCIMAGING.119.009986 10.1016/j.echo.2007.07.003 10.1016/j.echo.2019.02.014 10.1016/j.echo.2019.05.002 10.1093/eurheartj/ehs016 10.1016/j.echo.2021.10.009 10.1093/ehjci/jev078 10.1161/CIRCIMAGING.116.005444 10.1016/j.echo.2014.10.003 10.4103/jcecho.jcecho_57_20 10.1016/j.echo.2020.05.003 10.1093/eurheartj/eht296 10.1016/j.echo.2019.07.001 10.1007/s00259-019-04278-8 10.7326/M14-0296 10.1093/ehjci/jey131 10.1016/j.jacc.2017.12.064 10.1016/j.echo.2019.11.018 10.1016/j.echo.2011.03.007 10.1016/j.echo.2007.01.029 10.1016/j.echo.2019.12.015 10.1007/s12350-018-1283-y 10.1093/ehjci/jey188 10.1161/CIR.0000000000001029 10.4103/jcecho.jcecho_37_24 10.1016/j.echo.2021.11.010 10.1097/ACM.0000000000003122 |
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| Keywords | global longitudinal strain global myocardial work index dobutamine stress echocardiography pressure strain loop global myocardial work efficiency |
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| SubjectTerms | Cardiovascular Medicine dobutamine stress echocardiography global longitudinal strain global myocardial work efficiency global myocardial work index pressure strain loop |
| Title | Peak myocardial work assessment to detect coronary ischemia during dobutamine stress echocardiography |
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