The non-invasive assessment of myocardial work by pressure-strain analysis: clinical applications

Abstract

Pressure–volume (PV) analysis is the most comprehensive way to describe cardiac function, giving insights into cardiac mechanics and energetics. However, PV analysis still remains a highly invasive and time-consuming method, preventing it from integration into clinical practice. Most of the echocardiographic parameters currently used in the clinical routine to characterize left ventricular (LV) systolic function, such as LV ejection fraction and LV global longitudinal strain, do not take the pressure developed within the LV into account and therefore fall too short in describing LV function as a hydraulic pump. Recently, LV pressure-strain analysis has been introduced as a new technique to assess myocardial work in a non-invasive fashion. This new method showed new insights in comparison to invasive measurements and was validated in different cardiac pathologies, e.g., for the detection of coronary artery disease, cardiac resynchronization therapy (CRT)-response prediction, and different forms of heart failure. Non-invasively assessed myocardial work may play a major role in guiding therapies and estimating prognosis. However, its incremental prognostic validity in comparison to common echocardiographic parameters remains unclear. This review aims to provide an overview of pressure-strain analysis, including its current application in the clinical arena, as well as potential fields of exploitation.

Reference Values of Noninvasive Myocardial Work Indices Measured by Echocardiography in Healthy Children

“…As previously reported ( 19 ), myocardial work is derived from longitudinal strain and LV pressure. First, the segmental strain rate (expressed as %/s) was obtained by differentiating the segmental strain (%).…”

“…Analysis was performed according to the vendor's instructions and described by previous studies ( 18 , 19 ). Echopac version 203 (GE vingmed ultrasound, Horten, Norway) was used for image analysis.…”

Impact of Increasing Lower Body Negative Pressure and Its Abrupt Release on Left Ventricular Hemodynamics in Anesthetized Pigs

“…In conclusion, studies investigating the long-term effects of LBNP on cardiac performance are required to confirm these preliminary observations. The development of non-invasive, echocardiographic tools for assessment of cardiac work and efficiency [ 11 ], such as pressure–strain analysis, are therefore very suited to translate this concept into the human application.…”

“…Invasive pressure–volume assessment via a conductance catheter is considered the gold standard for directly measuring real-time, beat-to-beat LV function and mechanics [ 11 ]. We therefore set out to investigate the immediate hemodynamic alterations occurring during LBNP in acutely anesthetized healthy Landrace pigs, fully instrumented for LV and right ventricular (RV) assessment.…”

Evaluation of the effectiveness of the chronic heart failure therapy using the device cardiac contractility modulation according to the new non-invasive method of the myocardium work analysis

“…Методика определения работы миокарда ЛЖ в настоящее время используется в диагностике различных патологий, в частности, при ИБС, амилоидозе, гипертрофической и дилатационной кардиомиопатии, при прогнозировании ответа на ресинхронизирующую терапию (CRT) [10]. Интерес представляет также изучение работы миокарда у пациентов с ХСН, особенно в свете определения эффективности различных способов терапии, способствующих обратному ремоделированию сердца.…”