A new approach to assess myocardial work by non-invasive left ventricular pressure–strain relations in hypertension and dilated cardiomyopathy

Chan, Jonathan; Edwards, Natalie; Khandheria, Bijoy K.; Shiino, Kenji; Sabapathy, Surendran; Anderson, Bonita; Chamberlain, Robert G.; Scalia, G.

doi:10.1093/ehjci/jey131

Cited by 248 publications

(271 citation statements)

References 21 publications

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“…When comparing modern work indices with classic echocardiographic parameters, the patients with a lower GWI were found to exhibit more pronounced left ventricular remodelling with a greater LVEDV, a lower ejection fraction, and a lower stroke volume (Table 4B). This matches with the results of other studies on myocardial work measures in heart failure patients . As GWI is a parameter of left ventricular contraction, it did not show a significant correlation with diastolic parameters, for example E/e´ and deceleration time, or with markers of right ventricular function, for example TAPSE.…”

Section: Discussionsupporting

confidence: 90%

“…In a large multicenter study, the median GWI of healthy subjects was 1896 ± 308 mm Hg% . Other studies showed significantly lower GWI values of 1078 ± 506 mm Hg% in patients with dilated cardiomyopathy . We focused on patients with severe heart failure in a center specialized in heart transplantation and assist device implantation.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been studied additionally in acute coronary syndrome where it may serve as an important tool for selecting patients in need for prompt invasive treatment . Furthermore, myocardial work has been shown to be impaired in patients with hypertrophic cardiomyopathy and left ventricular fibrosis and in patients with dilated cardiomyopathy compared to control groups …”

Section: Introductionmentioning

confidence: 99%

“…8 Furthermore, myocardial work has been shown to be impaired in patients with hypertrophic cardiomyopathy and left ventricular fibrosis and in patients with dilated cardiomyopathy compared to control groups. 9,10 The aim of this study was to investigate the relationship between the new measures of noninvasive pressure-strain analysis and established prognostic parameters of echocardiography, CPX, and biomarkers.…”

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confidence: 99%

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Global work index correlates with established prognostic parameters of heart failure

et al. 2020

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Aim Identification of patients with heart failure and a poor prognosis is paramount to ensure timely and adequate treatment. We investigated the relationship between the new measures of noninvasive pressure‐strain analysis, such as the global work index (GWI), and established prognostic parameters of echocardiography, cardiopulmonary exercise test (CPX), and N‐terminal pro‐B‐type natriuretic peptide (NT‐pro‐BNP). Methods and Results We retrospectively analyzed data of 51 patients with heart failure. Echocardiography and CPX were performed, and NT‐pro‐BNP was determined. Patients with a GWI < 500 mm Hg% had a mean LVEDV of 286.1 ± 100.8 mL, an LVEF of 21.3 ± 5.7%, and a stroke volume (SV) of 45.9 ± 11.6 mL, and patients with a GWI > 1000 mm Hg% had an LVEDV of 147.9 ± 39.6 mL, an LVEF of 42.6 ± 4.8%, and a SV of 70.9 ± 14.3 mL. The GWI also showed a significant correlation with peak oxygen consumption (peak VO2) (r = .521; P < .001) and with NT‐pro‐BNP (r = .635; P < .001). Patients with a GWI of <500 mm Hg% had a significantly higher NT‐pro‐BNP (median 2415 pg/mL [IQR 1071, 5933]) and a lower peak VO2 (9.5 mL/min/kg ± 2.6) compared to patients with a GWI of >1000 mm Hg% (NT‐pro‐BNP median 253 pg/mL [IQR 150, 549]; peak VO2 15.6 ± 4.2 mL/min/kg). Conclusion GWI correlates with known prognostic markers of heart failure. A GWI of <500 mm Hg% was a predictor of severely impaired ejection fraction, very low exercise capacity, and strongly elevated NT‐pro‐BNP, indicating a poor prognosis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Global work index correlates with established prognostic parameters of heart failure

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“…Despite a similar variability has been observed in previous works on this topic, it might represent a weakness and prevents the application of MW to clinical practice and for patients’ management. Until now, the analysis of MW by pressure‐strain loops has been performed in a limited number of patients with very heterogeneous clinical conditions including arterial hypertension, dilated cardiomyopathy, hypertrophic cardiomyopathy, and heart failure patients undergoing cardiac resynchronization therapy . Nevertheless, the estimation of MW is strongly influenced by local and global LV geometry.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic reference ranges for myocardial work in healthy subjects: A preliminary study

et al. 2019

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Background Myocardial work (MW) estimation by pressure‐strain loops (PSL) allows the non‐invasive assessment of myocardial performance. Aim of this study is to provide the reference values for global myocardial work index (WI), constructive work (CW), wasted work (WW), and work efficiency (WE) in a group of healthy volunteers accounting for age and gender. Methods and results 2D standard and speckle‐tracking echocardiography were performed in 115 healthy volunteers (median age 36.3 [18–69] years, males: 67%). PSLs were used to assess MW. Mean ± standard deviation or median and inter‐quartile range, 5° and 95° percentile values for global myocardial WI, CW, WW, and WE in the whole population were 1926 ± 247 mm Hg, (1534–2356); 2224 ± 229 mm Hg, (1894–2647); 90 (61–123) mm Hg%, (38–195); and 96 (94–97)%, (91–98), respectively. Global WI (2031 ± 247 vs 1874 ± 232 mm Hg%, P = .001) and global CW (2289 ± 261 vs 2194 ± 207 mm Hg%, P = .04) were higher in women than in men. Age did not affect MW parameters. The segmental analysis showed that myocardial WI, CW, and WE were lower in the left ventricular basal segments than in the apex. The apex‐to‐base gradient was inverted for WW (all P < .0001). Conclusions The assessment of MW is feasible in normal subjects. The presented referral ranges of global myocardial WI, CW, WW, and WE were not affected by age. An apex‐to‐base gradient was observed for all MW parameters. Nevertheless, the wide variability of MW parameters prevents for the moment the application of this technique in the routine clinical setting.

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Association Between Malignant Mitral Valve Prolapse and Sudden Cardiac Death

et al. 2020

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IMPORTANCE Malignant arrhythmic mitral valve prolapse (MVP) phenotype poses a substantial risk of sudden cardiac death (SCD), and an estimated 26 000 individuals in the United States are at risk of SCD per year. Thus, identifying risk-stratification strategies for SCD is imperative.OBSERVATIONS Patients with MVP have a heterogenous clinical spectrum, ranging from a benign course to a devastating complication such as SCD. Some of the high-risk markers of MVP, which are identified electrocardiographically, include inverted or biphasic T waves, QT dispersion, QT prolongation, and premature ventricular contractions originating from the left ventricular outflow tract and papillary muscles. Morphofunctional characteristics of SCD are leaflet thickness of 5 mm or greater, mitral annulus disjunction, paradoxical systolic increase of the mitral annulus diameter, increased tissue Doppler velocity of the mitral annulus, and higher mechanical dispersion on echocardiography and fibrosis identified by late gadolinium enhancement on cardiac magnetic resonance imaging.CONCLUSIONS AND RELEVANCE Findings from this review suggest that SCD can occur earlier in the course of MVP from complex arrhythmias that are triggered by the repeated tugging and traction of the chordopapillary muscle unit and basal mid-myocardium, even before macrofibrosis can be identified in these regions by late gadolinium enhancement on cardiac magnetic resonance imaging. Some of the newer markers identified by speckle-tracking Doppler, such as mechanical dispersion, myocardial work index, and postsystolic shortening, need further validation in a larger population.

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A new approach to assess myocardial work by non-invasive left ventricular pressure–strain relations in hypertension and dilated cardiomyopathy

Abstract: GWI is a potential new technique that allows better understanding of the relationship between LV remodelling and increased wall stress under different loading conditions.

Cited by 248 publications

References 21 publications

Global work index correlates with established prognostic parameters of heart failure

Global work index correlates with established prognostic parameters of heart failure

Echocardiographic reference ranges for myocardial work in healthy subjects: A preliminary study

Association Between Malignant Mitral Valve Prolapse and Sudden Cardiac Death

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