Usability of Myocardial Work Parameters in Demonstrating Myocardial Involvement in INOCA Patients

Background: Myocardial work (MW) is a novel echocardiographic modality, which has been shown to have diagnostic and prognostic values in patients with cardiovascular diseases, patients with obstructive coronary artery disease, in particular. However, only a handful of studies have examined the MW analysis in ischemia with nonobstructive coronary artery (INOCA) disease. This study, therefore, aimed to detect the early left ventricular involvement in INOCA patients diagnosed by an invasive coronary angiography performing the MW analysis. Methods: This study included a total of 119 patients with nonobstructive coronary artery disease diagnosed by invasive coronary angiography, who were checked for prior ischemia tests performing myocardial perfusion scintigraphy. Out of these 119 patients, 49 patients developed ischemia (i.e., ischemic group) diagnosed using cardiac single-photon emission computed tomography, whereas 70 patients did not (i.e., nonischemic group). The subjects were divided into three groups based on the global MW tertiles. The groups were compared in terms of the conventional, longitudinal strain, and MW findings by conducting echocardiographic examinations. Results: The study subjects were divided into three groups based on the global constrictive work (GCW) value. The three groups were not statistically different in terms of the mean age of the patients (53.0 +/- 12 vs. 52.4 +/- 13.3 vs. 52.1 +/- 12.3; p = 0.96). Furthermore, the three groups were not statistically different regarding the gender, height, weight, and laboratory parameters of the patients except albumin. There was no statistically difference among the tertiles of GCW groups in the measurements of cardiac chambers, LA diameter, interventricular septum, E wave, and A wave. Also, there was no statistical difference in tissue Doppler recordings. The parameters associated with MW were examined, three groups were not statistically different in terms of the global waste work (GWW) (116 +/- 92, 122 +/- 73, 135 +/- 62, p = 0.52, respectively). In contrast, the three groups were different regarding the Global work index (GWI) (1716 +/- 300, 1999 +/- 130, 2253 +/- 195, p < 0.001, respectively), GCW (1888 +/- 206, 2298 +/- 75, 2614 +/- 155, p < 0.001, respectively), and Global work efficiency parameters (92.8 +/- 3.6, 94.4 +/- 3.2, 95.1 +/- 1.8 p = 0.004, respectively). Conclusion: It was concluded that the MW parameters GCW and GWI may have been used for predicting INOCA in patients.