Non-invasive myocardial work in coronary artery disease: a study of diagnostic accuracy and correlation with angiographic severity
M A Mahfoudhi, S Antit, I Ellouz, E Boussabah, L ZakhamaAbstract
Introduction
Myocardial work is an echocardiographic approach developed to assess left ventricular function, quantified through four parameters: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). This technique was recently suggested as an accurate tool to predict coronary stenosis. The aim of this study was to evaluate the diagnostic value of myocardial work parameters for coronary artery disease (CAD) and its correlation with the severity of coronary lesions.
Methodology
We conducted a prospective cohort study between March 1, 2025, and October 31, 2025. Patients included were those hospitalized with a clinical indication for invasive coronary angiography and no history of CAD. A comprehensive echocardiographic examination was performed within 24 hours before coronary angiography to assess GWI, GCW, GWW and GWE. Main exclusion criteria were altered ejection fraction, regional wall motion abnormalities, left bundle branch block and atrial fibrillation. Patients were divided into two groups based on their coronary status: those without coronary artery disease (G1) and those with significant obstructive coronary stenosis (G2). The Gensini score was calculated to assess the severity of CAD.
Results
We included 61 patients with a mean age of 57 ± 10 years and a sex ratio of 2.2, divided into two groups (G1, n=24, G2, n=37). The primary indications for coronary angiography were chronic coronary syndrome (24%), non-ST-elevation myocardial infarction (23%), and unstable angina (14%). The median ejection fraction was 59% [56-62]. The median absolute value of global longitudinal strain was 19% [17-20]. Patients in G2 had lower GWI (1948 ± 312 mmHg% in G1 vs. 1560 ± 321 mmHg% in G2, p<0.001) and GCW (2207 ± 296 mmHg% in G1 vs. 1826 ± 356 mmHg% in G2, p<0.001). There was no significant difference between the two groups in GWW and GWE. Receiver operating characteristic analysis was performed to evaluate the discriminative value of myocardial work parameters in detecting CAD between the two groups. Both GWI and GCW demonstrated a good diagnostic value (GWI: Area under the curve = 0.809, cut-off = 1683 mmHg%, sensitivity=83%, specificity=70%, p<0.001, GCW: Area under the curve = 0.815, cut-off = 1773 mmHg%, sensitivity=95%, specificity=62%, p<0.001). Statistical analysis revealed moderate inverse correlations between the Gensini score and both global work index (GWI; ρ = -0.571, p<0.001) and global constructive work (GCW; ρ = -0.548, p<0.001). This result indicates that a higher burden of coronary lesions is significantly associated with greater impairment of GWI and GCW.
Conclusion
Our study demonstrates that GWI and GCW are accurate in diagnosing CAD and significantly correlated with the severity of coronary lesions.