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Funding Acknowledgements ESC Training Grant 2019 Background Non-invasive prediction of critical coronary artery stenosis (CCS) is challenging. CCS may cause persistent impaired longitudinal function at rest, which could be detected by two-dimensional speckle tracking echocardiography (2D-STE). However, strain parameters are load dependent, hence they might not reflect systolic function accurately. A novel non-invasive method to calculate MW recently showed a strong correlation with invasive work measurements. Objectives To investigate the ability of non-invasive Myocardial Work (MW) indices: 1) to identify the ischaemic risk area during acute coronary occlusion (ACO); 2) to predict the ischaemic risk area underlying a CCS before coronary angiography. Methods The study population comprises 80 individuals: fifty consecutive patients (pts) referred for coronary angiography in a single tertiary coronary care centre and thirty controls (CTRL). Echocardiography recordings (GE-Healthcare) with systolic and diastolic non-invasive pressures, were obtained immediately before coronary angiography, during ACO, and immediately after revascularization to measure longitudinal strain along with myocardial work indices: Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial work efficiency (MWE). Results Compared to baseline, we found a significant reduction of global longitudinal strain (GLS) (p = 0.005), MWI, MCW and MWE (p &amp;lt; 0.001) during ACO. After the procedure, we observed a significant improvement in GLS, MWI, MCW and MWE (p &amp;lt; 0.001) compared to the findings obtained during CO. Interestingly, baseline global MWI, MCW and MWE were significantly reduced in pts with CCS at angiography compared to controls (p &amp;lt; 0.05). Moreover, regional MWE, but not longitudinal strain, measured within the myocardial segments underlying the CCS, was significantly reduced compared to non-target segments (p &amp;lt; 0.001). Conclusions Our results demonstrate that non-invasive estimation of regional and global MW parameters are able to identify myocardial ischemia upon ACO. Moreover, myocardial work indices measured at rest were able to predict the presence of CCS before invasive angiography, whereas MWE was more sensitive than myocardial strain to document regional impairment of myocardial function. Abstract 157 Figure.

157 Reduced non-invasive myocardial work predicts significant coronary artery disease