Title: Predictive Value of Non-Invasive Echocardiographic Based Myocardial Work Indices for Significant Coronary Artery Disease

Background: Among patients with preserved ejection fraction, non-invasive assessment of significant coronary artery disease remains challenging. Myocardial work indices provide a load-adjusted measure of myocardial function that may enhance CAD detection. Aim of work: To determine the effectiveness of global and regional myocardial work indices in detecting significant CAD among patients with intact left ventricular ejection fraction and without regional wall motion abnormalities. Methods: A cross-sectional approach was conducted on 122 patients with suspected coronary artery disease, all with preserved LVEF, who underwent clinical assessment, echocardiography with myocardial work analysis, and coronary angiography. According to angiographic results, patients were classified into significant and non-significant stenosis groups. Stenosis severity was assessed by blinded cardiologists, and myocardial work indices were evaluated using logistic regression and ROC analysis. Results: A marked decline in myocardial work indices (GWI, GCW, and GWE), besides GLS, was observed among patients having significant CAD (p < 0.001 for all). Yielding an AUC of 0.917, GWE proved to be the most reliable predictor of significant coronary artery disease (p < 0.001; cutoff ≤94%; sensitivity 68.85%, specificity 96.72%), followed by GCW, IVSd, and LV mass index. Multivariate logistic regression confirmed GWE (OR .323, 95% CI: .176–.592, p < 0.001) and GCW (OR .994, 95% CI: .990–.998, p < 0.001) as key predictors of significant CAD. Myocardial work indices did not differ between single and multi-vessel CAD.