Estimation of myocardial work from pressure–strain loops analysis: an experimental evaluation

Hubert, Arnaud; Rolle, Virginie Le; Leclercq, Christophe; Galli, Elena; Samset, Eigil; Casset, C.; Mabo, Philippe; Hernández, Alfredo; Donal, Erwan

doi:10.1093/ehjci/jey024

Cited by 177 publications

(166 citation statements)

References 21 publications

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“…,15,25 In the present study, we show that in patients with severe functional mitral regurgitation, myocardial constructive work is able to detect subtle improvement in LV performance, despite the absence of modification in GLS or LVEF. In a previous study, we demonstrated that a significant reduction in myocardial constructive work is associated with poor LV remodeling after CRT 24.…”

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confidence: 53%

“…The area within the PSL is used for the calculation of myocardial work parameters: global constructive work (GCW, work performed during shortening in systole adding negative work during lengthening in isovolumetric relaxation); global wasted work (GWW, negative work performed during lengthening in systole adding work performed during shortening in isovolumetric relaxation); global work index (GWI, constructive work subtracted by wasted work); and global work efficiency (GWE, constructive work divided by the sum of constructive and wasted work) (Figure 1) 15. The software then constructs a non-invasive LV pressure curve adjusted according to the duration of isovolumic and ejection phases defined by valvular timing events at echocardiography.…”

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confidence: 99%

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Left ventricular function after correction of mitral regurgitation: Impact of the clipping approach

et al. 2019

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Aims Functional mitral regurgitation (FMR) is associated with poor outcome in systolic heart failure (HF) patients. Percutaneous edge‐to‐edge mitral valve repair (PMVR) in Mitra‐Fr study failed to prove any beneficial effect over optimal medical treatment (OMT) but win in COAPT study. Nevertheless, little is known about the effect of PMVR on LV performance and mechanics in HF patients with severe secondary MR. Method and results Thirty‐seven patients with severe FMR undergoing PMVR were included and compared (according to indices of LV myocardial function and the relationship between LV‐size and the degree of regurgitation) to nineteen patients with FMR treated by OMT. Both groups were clinically comparable. At 6‐month follow‐up, cardiac index such as LV global constructive work (GCW) improved significantly in both groups (1.86 vs 2.13 L/min/m2, P = .02, 1.73 vs 2.28 L/min/m2 P = .002 and 977 vs 1101 mm Hg.%, P = .003, 967 vs 1110 mm Hg.%, P = .002 for PMVR and OMT groups, respectively) whereas left ventricular (LV) end‐systolic volume index, LV ejection fraction, and global longitudinal strain were not different. Receiver operating characteristics in PMVR with LVEF ≤ 35% subgroup analysis demonstrated that global work index (GWI) had the best ability to identify patients with worse evolution (AUC = 0.882; P = .009), confirmed by univariable logistic regression, particularly for patients with GWI < 482 mm Hg.%. Conclusion Echocardiographic characteristics at 6‐month follow‐up are not different when compare PMVR and OMT for HF patients with severe FMR. A low global work index might be a tool for discouraging the implantation of clips for this indication.

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confidence: 99%

Left ventricular function after correction of mitral regurgitation: Impact of the clipping approach

et al. 2019

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“…The modern measurement of myocardial work using brachial artery cuff pressure and left ventricular strain analysis is based on the calculation of pressure‐strain loops . The global myocardial work indices obtained by this method correlate strongly with invasive measurements . These results raise the question of the relevance of myocardial work indices in daily practice, and in particular, their usefulness for estimating the severity and predicting the outcome in patients with heart failure.…”

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confidence: 99%

“…6 The global myocardial work indices obtained by this method correlate strongly with invasive measurements. 14 Normal values have recently been published and work indices have been measured in patients with heart failure. 7,9,15 This work describes for the first time the relation between classic prognostic parameters and work indices in a heart failure population.…”

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confidence: 99%

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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“…Russel et al recently proposed a method for the non‐invasive estimation of regional and global myocardial work (MW) from pressure‐strain loops (PSLs) analysis . The non‐invasive evaluation of (MW) was validated against the invasive estimation of myocardial performance in patients with CRT, and other cardiac pathologies . PSLs areas were shown to be strongly associated with myocardial oxygen consumption measured at PET, and myocardial constructive work emerged as a predictor of CRT response in heart failure patients undergoing CRT implantation …”

Section: Introductionmentioning

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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Estimation of myocardial work from pressure–strain loops analysis: an experimental evaluation

Abstract: The non-invasive estimation for LV pressure-strain loop area and the global myocardial work indices obtained from LV-PSL strongly correlates with invasive measurements.

Cited by 177 publications

References 21 publications

Left ventricular function after correction of mitral regurgitation: Impact of the clipping approach

Left ventricular function after correction of mitral regurgitation: Impact of the clipping approach

Global work index correlates with established prognostic parameters of heart failure

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

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