Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality

Minhas, Anum; Gilotra, Nisha A.; Goerlich, Erin; Metkus, Thomas S.; Garibaldi, Brian T.; Sharma, Garima; Bavaro, Nicole; Phillip, Susan; Michos, Erin D.; Hays, Allison G.

doi:10.3389/fcvm.2021.667721

Cited by 29 publications

(34 citation statements)

References 56 publications

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“…In a retrospective cohort of 136 patients hospitalized for COVID-19, 79% of patients had abnormal MWE despite 81% had normal left ventricular ejection fraction. Higher MWE was associated with lower in-hospital mortality, in addition, increased systemic inflammation measured by interleukin-6 level was associated with reduced MWE [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities

et al. 2022

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Although the clinical manifestations of SARS-CoV-2 viral infection affect mainly the respiratory system, cardiac complications are common and are associated with increased morbidity and mortality. While echocardiographic alterations indicating myocardial involvement are widely reported in patients hospitalized for acute COVID-19 infection, much fewer data available in non-hospitalized, mildly symptomatic COVID-19 patients. In our work, we aimed to investigate subclinical cardiac alterations characterized by parameters provided by advanced echocardiographic techniques following mild SARS-CoV-2 viral infection. A total of 86 patients (30 males, age: 39.5 ± 13.0 yrs) were assessed 59 ± 33 days after mild SARS-CoV-2 viral infection (requiring no hospital or <5 days in-hospital treatment) by advanced echocardiographic examination including 2-dimensional (2D) speckle tracking echocardiography and non-invasive myocardial work analysis, and were compared to an age-and sex-matched control group. Altogether, variables from eleven echocardiographic categories representing morphological or functional echocardiographic parameters showed statistical difference between the post-COVID patient group and the control group. The magnitude of change was subtle or mild in the case of these parameters, ranging from 1–11.7% of relative change. Among the parameters, global longitudinal strain [−20.3 (−21.1–−19.0) vs. −19.1 (−20.4–−17.6) %; p = 0.0007], global myocardial work index [1975 (1789–2105) vs. 1829 (1656–2057) Hgmm%; p = 0.007] and right ventricular free wall strain values (−26.6 ± 3.80 vs. −23.8 ± 4.0%; p = 0.0003) showed the most significant differences between the two groups. Subclinical cardiac alterations are present following even mild SARS-CoV-2 viral infection. These more subtle alterations are difficult to detect by routine echocardiography. Extended protocols, involving speckle-tracking echocardiography, non-invasive measurement of cardiac hemodynamics, and possibly myocardial work are necessary for detection and adequate follow-up.

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Section: Discussionmentioning

confidence: 99%

Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities

et al. 2022

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“…MW has recently emerged as a promising technique which can provide a more precise evaluation of the LV function by incorporating the LV pressure-strain relationship [ 29 , 30 ]. Similarly, in a retrospective study on hospitalized COVID-19 patients, a decrease in MW efficiency was associated with inflammation burden and in-hospital mortality [ 41 ]. Other small reports also showed reduced GWI in the presence of normal LVEF and GLS during the acute setting of the COVID-19 with an improved near to normal GWI after one month [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Subclinical Myocardial Dysfunction in Patients with Persistent Dyspnea One Year after COVID-19

et al. 2021

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Long coronavirus disease 2019 (COVID-19) was described in patients recovering from COVID-19, with dyspnea being a frequent symptom. Data regarding the potential mechanisms of long COVID remain scarce. We investigated the presence of subclinical cardiac dysfunction, assessed by transthoracic echocardiography (TTE), in recovered COVID-19 patients with or without dyspnea, after exclusion of previous cardiopulmonary diseases. A total of 310 consecutive COVID-19 patients were prospectively included. Of those, 66 patients (mean age 51.3 ± 11.1 years, almost 60% males) without known cardiopulmonary diseases underwent one-year follow-up consisting of clinical evaluation, spirometry, chest computed tomography, and TTE. From there, 23 (34.8%) patients reported dyspnea. Left ventricle (LV) ejection fraction was not significantly different between patients with or without dyspnea (55.7 ± 4.6 versus (vs.) 57.6 ± 4.5, p = 0.131). Patients with dyspnea presented lower LV global longitudinal strain, global constructive work (GCW), and global work index (GWI) compared to asymptomatic patients (−19.9 ± 2.1 vs. −21.3 ± 2.3 p = 0.039; 2183.7 ± 487.9 vs. 2483.1 ± 422.4, p = 0.024; 1960.0 ± 396.2 vs. 2221.1 ± 407.9, p = 0.030). GCW and GWI were inversely and independently associated with dyspnea (p = 0.035, OR 0.998, 95% CI 0.997–1.000; p = 0.040, OR 0.998, 95% CI 0.997–1.000). Persistent dyspnea one-year after COVID-19 was present in more than a third of the recovered patients. GCW and GWI were the only echocardiographic parameters independently associated with symptoms, suggesting a decrease in myocardial performance and subclinical cardiac dysfunction.

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“…Recently, various studies have proved the diagnostic and prognostic values of GWE ( 6 – 12 ). However, the comparison of the diagnostic capability of GWE and myocardial layer-specific GLS during peak exercise in identifying significant CAD in patients without a history of CAD has not been explored prior to our study.…”

Section: Discussionmentioning

confidence: 99%

“…Global myocardial work efficiency (GWE) is one of the major MW parameters and is derived from the percentage ratio of constructive work to the sum of constructive work and wasted work. Recently, significantly lower GWE values were reported in patients with CAD, heart failure, hypertension with left ventricle hypertrophy, and COVID-19 (6)(7)(8)(9)(10), and the prognostic value of GWE was found to predict the longterm outcomes of patients after ST-segment elevation myocardial infarction (11) or patients after cardiac resynchronization therapy (12).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Myocardial Layer-Specific Strain and Global Myocardial Work Efficiency During Treadmill Exercise Stress in Detecting Significant Coronary Artery Disease

Lin

Gao

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundMyocardial layer-specific strain can identify myocardial ischemia. Global myocardial work efficiency (GWE) based on non-invasive left ventricular (LV) pressure-strain loops is a novel parameter to determine LV function considering afterload. The study aimed to compare the diagnostic value of GWE and myocardial layer-specific strain during treadmill exercise stress testing to detect significant coronary artery disease (CAD) with normal baseline wall motion.MethodsEighty-nine patients who referred for coronary angiography due to suspected of CAD were included. Forty patients with severe coronary artery stenosis were diagnosed with significant CAD, and 49 were defined as non-significant CAD. Stress echocardiography was performed 24 h before angiography. Layer-specific longitudinal strains were assessed from the endocardium, mid-myocardium, and epicardium by 2D speckle-tracking echocardiography. Binary logistic regression analyses were performed to evaluate the association between significant CAD and echocardiographic parameters. A receiver operating characteristic curve was used to assess the capability of layer-specific strain and GWE to diagnose significant CAD.ResultsPatients with significant CAD had the worse function in all three myocardial layers at peak exercise compared with those with non-significant CAD when assessed with global longitudinal strain (GLS). At the peak exercise and recovery periods, GWE was lower in patients with significant CAD than in patients with non-significant CAD. In multivariable binary logistic regression analysis, peak endocardial GLS (OR: 1.35, p = 0.006) and peak GWE (OR: 0.76, p = 0.001) were associated with significant CAD. Receiver operating characteristic curves showed peak GWE to be superior to mid-myocardial, epicardial, and endocardial GLS in identifying significant CAD. Further, adding peak GWE to endocardial GLS could improve diagnostic capabilities.ConclusionsBoth GWE and endocardial GLS contribute to improving the diagnostic performance of exercise stress echocardiography. Furthermore, adding peak GWE to peak endocardial GLS provides incremental diagnostic value during a non-invasive screening of significant CAD before radioactive or invasive examinations.

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Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality

Cited by 29 publications

References 56 publications

Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities

Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities

Subclinical Myocardial Dysfunction in Patients with Persistent Dyspnea One Year after COVID-19

Comparison of Myocardial Layer-Specific Strain and Global Myocardial Work Efficiency During Treadmill Exercise Stress in Detecting Significant Coronary Artery Disease

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