Association Between Myocardial Work and Coronary Artery Calcium Score in Patients With Chronic Kidney Disease

ABSTRACT Background Myocardial work is a novel measure of potential value for diagnosing coronary artery disease (CAD). It may therefore be useful in patients with chronic kidney disease (CKD), in whom the diagnostic work‐up can be challenging. Methods This was a cross‐sectional study of patients with CKD (G1‐5, nondialysis‐dependent). Cardiac computed tomography was performed to quantify coronary artery calcium score (CACS). Pressure‐strain loop analysis was performed to obtain global and territorial work index (GWI and TWI, respectively). Logistic regression was applied to investigate the association between work measures and high CACS (>400). Results We included 455 patients (age: 57 years, 60% men, 8% with previous CAD, and eGFR of 43 mL/min/1.73 m 2 ). High CACS across all coronary arteries was observed in 77 (17%), with 53 (12%) in the left anterior descending (LAD) artery, 28 (6%) in the right coronary artery (RCA), and 17 (4%) in the circumflex (Cx) artery. No difference in GWI was observed for overall high versus non‐high CACS (1861 vs. 1937 mmHg%, p = 0.14). TWI was reduced in patients with high versus non‐high CACS in the LAD (1772 vs. 1956 mmHg%, p = 0.003) and in the Cx (1556 vs. 1934 mmHg%, p = 0.001), but not in the RCA ( p = 0.68). After multivariable regression, TWI remained significantly associated with high CACS in the LAD and Cx in patients with no history of CAD, but not in the RCA. Conclusion In patients with CKD, GWI was not associated with an overall high CACS. TWI was, however, associated with a high CACS in specific coronary arteries, although the findings were inconsistent.