{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T23:42:39Z","timestamp":1777246959856,"version":"3.51.4"},"reference-count":21,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: While lifestyle changes, management of coronary artery disease (CAD) risk factors, myocardial revascularization procedures, and medication can improve a patient\u2019s prognosis, de novo native coronary lesions and in-stent restenosis (ISR) remain significant clinical concerns. ISR is more frequent with a bare-metal stent than with a drug-eluting stent and has been documented in around 12% of DES patients. Acute coronary syndrome (ACS) manifests as unstable angina in about 30% to 60% of ISR patients. Myocardial work imaging is a modern, non-invasive technique able to identify individuals with critical coronary artery lesions with high sensitivity and specificity. Case report: We present the case of a 72-year-old Caucasian gentleman with multiple cardiovascular risk factors, admitted to the Cardiology Clinic of Timi\u0219oara Municipal Hospital with unstable angina. From 1999 to 2021, the patient experienced two myocardial infarctions, a double aortocoronary bypass graft, and multiple percutaneous coronary interventions with 11 stent implantations, including 6 for ISR. Using two-dimensional speckle-tracking echocardiography and myocardial work assessment, we detected that the lateral wall of the left ventricle had a severely impaired deformation pattern. Angio-coronarography was performed, and sub-occlusion of the posterolateral branch of the right coronary artery was found. Angioplasty was performed and a DES was inserted, with a good final angiographic result and complete release of symptoms. Conclusion: In patients with a history of multiple myocardial revascularization interventions and ISR, it is challenging to identify the critical ischemia region by non-invasive methods. Myocardial work imaging was beneficial in the detection of the altered deformation patterns indicating significant ischemia, its accuracy being superior to that of LV strain, as proven by coronary angiography. Urgent coronary angiography followed by angioplasty and stent implantation resolved the issue.<\/jats:p>","DOI":"10.3390\/diagnostics13081459","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T05:18:13Z","timestamp":1681795093000},"page":"1459","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Myocardial Work Evaluation\u2014A Useful Non-Invasive Method to Predict Coronary Artery Sub-Occlusion in a Patient with Unstable Angina and Multiple Myocardial Revascularization Interventions"],"prefix":"10.3390","volume":"13","author":[{"given":"Alexandru","family":"Gheorghiu","sequence":"first","affiliation":[{"name":"Multidisciplinary Heart Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 12 Revolution of 1989 Bd., 300040 Timisoara, Romania"},{"name":"Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, 12 Revolution of 1989 Bd., 300040 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergiu-Florin","family":"Arnautu","sequence":"additional","affiliation":[{"name":"Multidisciplinary Heart Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 12 Revolution of 1989 Bd., 300040 Timisoara, Romania"},{"name":"Department of Internal Medicine, Victor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena","family":"Slovenski","sequence":"additional","affiliation":[{"name":"Multidisciplinary Heart Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 12 Revolution of 1989 Bd., 300040 Timisoara, Romania"},{"name":"Department of Internal Medicine, Victor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudiu-Daniel","family":"Mali\u021ba","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2117-0474","authenticated-orcid":false,"given":"Mirela-Cleopatra","family":"Tomescu","sequence":"additional","affiliation":[{"name":"Multidisciplinary Heart Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 12 Revolution of 1989 Bd., 300040 Timisoara, Romania"},{"name":"Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, 12 Revolution of 1989 Bd., 300040 Timisoara, Romania"},{"name":"Department of Internal Medicine, Victor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9959-5718","authenticated-orcid":false,"given":"Diana-Aurora","family":"Arnautu","sequence":"additional","affiliation":[{"name":"Multidisciplinary Heart Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 12 Revolution of 1989 Bd., 300040 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1016\/j.jacc.2019.10.009","article-title":"The global burden of cardiovascular diseases and risk factors: 2020 and beyond","volume":"74","author":"Mensah","year":"2019","journal-title":"J. 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