Background: Non-invasive identification of coronary stenosis in stable coronary artery disease (CAD) patients lacking regional wall motion abnormalities (RWMA) remains challenging. This study aimed to develop and validate a myocardial work-derived nomogram for predicting significant coronary stenosis in these patients. Methods: In this retrospective study, 181 consecutive patients with angiographically confirmed CAD, preserved LVEF (≥55%), and no resting wall motion abnormalities were enrolled. Global myocardial work efficiency (GWE) was assessed using echocardiographic pressure–strain loop analysis. A multivariable-derived nomogram incorporating GWE and clinical biomarkers was developed and externally validated for predicting severe coronary stenosis. Results: The nomogram incorporating GWE, lipoprotein-associated phospholipase A2 (LP-PLA2), N-terminal pro brain natriuretic peptide (NT-proBNP), and serum creatinine (Scr) demonstrated favorable discrimination in both the training set (AUC 0.916, 95% CI 0.866–0.952) and validation set (AUC 0.911, 95% CI 0.853–0.951), with good calibration (mean absolute error: 1.9% vs 3.2% in training vs validation, respectively). Decision curve analysis confirmed clinical utility across all probability thresholds. Conclusions: Our nomogram provides a non-invasive tool for preoperative risk stratification and optimizes the use of invasive diagnostics in stable CAD patients without RWMA.

Right ventricular (RV) dysfunction in patients with coronary artery disease (CAD) and concomitant pulmonary hypertension (PH) is associated with poor outcomes, yet its short-term reversibility after percutaneous coronary intervention (PCI) remains unclear. Identifying echocardiographic predictors of RV functional improvement may inform tailored therapeutic strategies. This single-center retrospective cohort study enrolled 160 CAD patients with systolic pulmonary artery pressure (sPAP > 65 mm Hg) undergoing PCI between January 2024 and February 2025. Echocardiography was performed within 7 days before and after PCI, assessing RV function via tricuspid annular plane systolic excursion (TAPSE), Tei index, and speckle-tracking-derived RV free wall strain (RVFWS) and global strain (RVGS). The primary outcome was ≥ 1-level improvement in NYHA class. At 7-day follow-up, 57.5% of patients improved, with increased TAPSE (13.8 mm to 15.1 mm, P = .004) and RVFWS (−17.0% to − 19.6%, P < .001), and decreased Tei index (0.45–0.41, P = .031) and sPAP (68 mm Hg to 62 mm Hg, P = .026). Multivariable analysis showed higher baseline TAPSE (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.03–1.86; P = .029) and lower Tei index (OR 0.70, 95% CI 0.51–0.96; P = .037) independently predicted RV recovery. The model demonstrated good discrimination (AUC = 0.78, 95% CI 0.71–0.85) and calibration (Hosmer–Lemeshow P = .735). Subgroup analysis confirmed consistent findings in preserved left ventricular ejection fraction and severe symptoms. In CAD patients with elevated pulmonary pressure, PCI facilitated early RV improvement, with baseline TAPSE and Tei index serving as useful predictors for risk stratification.

(1) Background: Our aim was to evaluate left atrial (LA) volumes and function in patients with newly diagnosed, treatment-naive type 2 diabetes mellitus (T2DM) using Four-Dimensional Automated Left Atrial Quantificative (four-dimensional auto LAQ) analysis and to explore the independent factors influencing left atrial function in diabetic patients. (2) Method: A total of 62 treatment-naive, newly diagnosed T2DM patients without hypertension or obesity and 50 healthy controls were prospectively enrolled in the study. All participants underwent laboratory analyses, routine echocardiography and 4D LAQ assessment. The parameters were compared between the two groups, and independent factors influencing left atrial function in diabetic patients were investigated through univariate and multivariate linear regression analyses. (3) Results: Despite no significant difference in LA end-systolic anteroposterior diameter between groups, LA volume parameters (LAVmax, LAVmin, LAVpreA, and LAVmaxI) were significantly increased in T2DM patients (all p < 0.05). Regarding LA strain, reservoir and conduit function were significantly impaired in T2DM patients, as reflected by lower LASr, LAScd, LASr-c, and LAScd-c (all p < 0.05). Conversely, circumferential contractile strain (LASct-c) was significantly higher in the T2DM group (p = 0.029), while longitudinal contractile strain (LASct) did not differ significantly between groups (p = 0.146). Multivariate analysis revealed that HbA1c and E/e’ ratio were independently associated with multiple LA strain parameters (all p < 0.05). (4) Conclusion: Newly diagnosed, treatment-naive patients with T2DM exhibited increased LA volumes, decreased left atrial ejection fraction (LAEF), and impaired reservoir and conduit functions, accompanied by a compensatory increase in contractile function. Furthermore, HbA1c and E/e’ demonstrated an independent correlation with 4D strain parameters. 4D Auto LAQ echocardiography may serve as a sensitive tool for early detection of diabetic atrial myopathy.