Myocardial Work Assessment in Patients after Coronary Artery Bypass Grafting during Cardiac Rehabilitation

Abstract

Background: Myocardial work is an innovative echocardiographic tool to assess left ventricular performance. Emerging data have shown the added value of this method for evaluating cardiac function compared to traditional echocardiographic parameters and global longitudinal strain. However, few studies are present in the literature about the role of myocardial work during cardiac rehabilitation. Our aim was to assess the impact of a rehabilitation program on myocardial work indices in patients with preserved left ventricular ejection fraction and after coronary artery bypass grafting. In addition, we assessed the correlation between baseline myocardial work indices and their change after cardiac rehabilitation, establishing an optimal cut-off value to predict the improvement. Methods: An observational, single-center, and prospective study was conducted. We enrolled patients referred to cardiac rehabilitation after coronary artery bypass grafting and with preserved left ventricular ejection fraction. Before and after the cardiac rehabilitation program, a comprehensive patient assessment was performed, including traditional transthoracic echocardiography, myocardial work analysis, and a six-minute walk test. Results: Eighty-four patients were enrolled; the mean age was 67.96 (±7.42) years and 78.6% were male. The left ventricular ejection fraction was preserved in all patients, and the global longitudinal strain was −16.18 ± 2.55%, the global work index was 1588.56 ± 345 mmHg%, the global constructive work was 1771.27 ± 366.36 mmHg%, the global wasted work was 105.8 ± 72.02 mmHg%, and the global work efficiency was 92.63 ± 3.9% at baseline. After the cardiac rehabilitation program, the global work index, the global constructive work, and the six-minute walk test improved significantly (1588.56 ± 345 vs. 1960.2 ± 377.03 mmHg%, p-value < 0.001; 1771.27 ± 366.36 vs. 2172.01 ± 418.73 mmHg%, p-value < 0.001; 70.71 ± 40.2 vs. 437.5 ± 108.70 m, p-value < 0.001, respectively). Conclusions: Myocardial work indices, specifically global work index and global constructive work, improve after cardiac rehabilitation program in patients undergoing coronary artery bypass grafting with preserved left ventricular ejection fraction.

The Clinical Outcome of Cardiac Rehabilitation in Coronary Artery Disease Patients with Regard to the Presence of Left Ventricular Systolic Dysfunction

“…The answer to this problem may be the use of new echocardiography techniques and more sensitive parameters of myocardial dysfunction in further research, especially in the individuals with preserved LVEF. Studies in recent years have shown that both global longitudinal strain and myocardial work can be early indicators of improvement in myocardial function after a cycle of physical training, independently of other clinical factors [52,53]. Their analysis in the context of physical performance could provide additional information influencing the overall management and prognosis assessment, especially in the group of patients who do not achieve significant clinical improvement after CR.…”