ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1598453
This article is part of the Research TopicOptimizing Revascularization and Conservative Therapy in Chronic Coronary SyndromeView all 10 articles
Reserve of Global Constructive Work for Early Diagnosis of Myocardial Ischemia and Risk Stratification in Chronic Coronary Syndrome
Provisionally accepted
Ruohan Zhao1
Jing Zhang1Yu Xie1
Yuting Tan1Benling Qi2Lijuan Bai2Jingjing Wu3
Min Cheng3Xiang Wang3*
Qing Lv1*
Jing Wang1*
Mingxing Xie1*- 1Department of Ultrasound Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 2Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- 3Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Background: In chronic coronary syndrome (CCS), assessing myocardial ischemia is difficult due to its variable severity. Myocardial mechanical parameters are helpful in detecting ischemia. This study investigates the use of non-invasive myocardial work (MW), for ischemia detection and risk assessment in CCS patients. Method: The study included 115 patients (70 men, mean age 61 years) with suspected or diagnosed CCS in the derivation cohort, and 62 patients in the validation cohort. They underwent regadenoson stress echocardiography, with early ischemia indicated by coronary flow velocity reserve (CFVR) <2.5. Patients were categorized by CFVR and logistic regression was used to assess the association between myocardial work (MW) and ischemia. Model performance was evaluated for accuracy, prediction, and practicality. The risk stratification thresholds were set by sensitivity and specificity. Results: Of the 115 patients, 48 (41.74%) had myocardial ischemia. MW was more sensitive to detect ischemia than global longitudinal strain. Multivariate analysis showed that global constructive work reserve (△GCW) was independently correlated with CFVR, with the highest AUC (0.777). A model including △GCW and hemoglobin identified ischemia with a C-index of 0.844 in derivation cohort and 0.82 in validation cohort, allowing calculation of the probability of ischemia in CCS. Risk levels were defined by probabilities of 20% (low) and 70% (high). Conclusion: The incorporation of △GCW, and hemoglobin into the prediction model enhances its ability to estimate myocardial ischemia risk. △GCW offered higher sensitivity and incremental diagnostic value in detecting myocardial ischemia in the heterogeneous CCS population. Keyword: chronic coronary syndrome, myocardial ischemia, myocardial work, stress echocardiography
Keywords: Chronic coronary syndrome, Myocardial Ischemia, myocardial work, Stress echocardiography, Coronary flow velocity reserve
Received: 23 Mar 2025; Accepted: 10 Jul 2025.
Copyright: © 2025 Zhao, Zhang, Xie, Tan, Qi, Bai, Wu, Cheng, Wang, Lv, Wang and Xie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiang Wang, Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
Qing Lv, Department of Ultrasound Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Jing Wang, Department of Ultrasound Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Mingxing Xie, Department of Ultrasound Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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