Global Myocardial Work-Derived Nomogram for Coronary Stenosis Assessment in Stable Coronary Artery Disease:...

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Tools

Background:

• Non-invasive identification of coronary stenosis in stable coronary artery disease (CAD) patients lacking regional wall motion abnormalities (RWMA) is difficult.
• Current diagnostic methods may involve invasive procedures, posing risks and increasing healthcare costs.
• There is a need for accurate, non-invasive tools to assess stenosis severity in this specific patient group.

Purpose of the Study:

• To develop and validate a nomogram using myocardial work-derived parameters and clinical biomarkers for predicting significant coronary stenosis.
• To provide a non-invasive tool for risk stratification in stable CAD patients without RWMA.
• To optimize the use of invasive diagnostic procedures.

Main Methods:

• Retrospective study of 181 patients with confirmed CAD, preserved LVEF, and no resting RWMA.
• Global myocardial work efficiency (GWE) assessed via echocardiographic pressure-strain loop analysis.
• Development and external validation of a multivariable nomogram incorporating GWE and biomarkers (LP-PLA2, NT-proBNP, Scr).

Main Results:

• The nomogram incorporating GWE, LP-PLA2, NT-proBNP, and Scr showed high predictive accuracy (AUC 0.916 training, 0.911 validation).
• The model demonstrated good calibration in both training and validation sets.
• Decision curve analysis confirmed the clinical utility of the nomogram across various probability thresholds.

Conclusions:

• The developed nomogram offers a valuable non-invasive method for predicting significant coronary stenosis in stable CAD patients without RWMA.
• This tool can aid in preoperative risk stratification and improve the efficiency of invasive diagnostic testing.
• The findings support the integration of myocardial work analysis into routine clinical practice for selected CAD patients.