Myocardial work in Stage 1 and 2 hypertensive patients

Abstract

Aims Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension. Methods and results Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure–strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P < 0.001), and GWW (P < 0.001). Conclusion Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.

Performance of non‐invasive myocardial work to predict the first hospitalization for de novo heart failure with preserved ejection fraction

“…25 The added clinical value of LV MW has been demonstrated in patients with hypertension or in aiding the prognostic stratification in patients with cardiac amyloidosis and ST-segment elevation myocardial infarction. 32,33 Furthermore, in the HFpEF setting, Przewlocka-Kosmala et al demonstrated that GCW is a better determinant of exercise capacity than GLS and that improvement in functional capacity during follow-up is associated with increment of GCW. 34 Using longitudinal MW analyses, the current study is the first to point out at the role of MW in the risk stratification of HFpEF patients and its association with clinical outcomes.…”

Impact of blood pressure changes on myocardial work indices in hypertensive patients in a day

“…P2: Compared to B1, the area of the red segment of bull's-eye was found to be reduced while the corresponding GLS and GWE were shown to be improved in the B2 (B1, BP 172/92 mmHg; B2, BP 135/80 mmHg) elevated in both Stage 1 and Stage 2 hypertension. 27 Furthermore,…”

Strain Imaging for the Early Detection of Cardiac Remodeling and Dysfunction in Primary Aldosteronism

“…Chan J et al first investigated myocardial work analysis in hypertensive patients and found that GWIand GCW were comparable in patients with stage 1 hypertension and normotensive control subjects, but significantly increased in patients with stage 2 and 3 hypertension [ 76 ], though GWW and GWE remained similar among all groups. Jaglan A et al, on the other hand, found a significant increase in GWW in addition to the similar significant differences in GWI and GCW in patients with stage 1 and 2 hypertension and normotensive subjects [ 77 ]. Nonetheless, it should be noted that the global longitudinal strain in these studies were all comparable between groups, suggesting that these patients were in the early stage of cardiac remodeling and dysfunction.…”