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Chakraborty S, Bhattacharya S, Meyers BA, Sepúlveda MS, Vlachos PP. Evolution of cardiac tissue and flow mechanics in developing Japanese Medaka. PLoS One 2024; 19:e0309018. [PMID: 39186731 PMCID: PMC11346936 DOI: 10.1371/journal.pone.0309018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 08/03/2024] [Indexed: 08/28/2024] Open
Abstract
The effects of pressure drop across cardiac valve cushion regions and endocardial wall strain in the early developmental stages of a teleost species heart are poorly understood. In the presented work, we utilize microscale particle image velocimetry (μPIV) flow measurements of developing medaka hearts from 3 to 14 dpf (n = 5 at each dpf) to quantify the pressure field and endocardial wall strain. Peak pressure drop at the atrioventricular canal (ΔPAVC) and outflow tract (ΔPOFT) show a steady increase with fish age progression. Pressure drops when non-dimensionalized with blood viscosity and heart rate at each dpf are comparable with measurements in zebrafish hearts. Retrograde flows captured at these regions display a negative pressure drop. A novel metric, Endocardial Work (EW), is introduced by analyzing the ΔPAVC-strain curves, which is a non-invasive measure of work required for ventricle filling. EW is a metric that can differentiate between the linear heart stage (< 100 Pa-%), cardiac looped chamber stage (< 300 Pa-%), and the fully formed chamber stage (> 300 Pa-%).
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Affiliation(s)
- Sreyashi Chakraborty
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Sayantan Bhattacharya
- Department of Mechanical Engineering, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
| | - Brett Albert Meyers
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Maria S. Sepúlveda
- Department of Forestry & Natural Resources, Purdue University, West Lafayette, Indiana, United States of America
| | - Pavlos P. Vlachos
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana, United States of America
- Department of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States of America
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Cagan Efe S, Buğrahan Cicek M, Unkun T, Yucel E, Karagöz A, Doğan C, Bayram Z, Tekatlı AF, Bozan B, Karaçam M, Halil GS, Karabağ T, Kaymaz C, Ozdemir N. Usability of myocardial work parameters to demonstrate subclinical myocardial involvement in normotensive individuals with exaggerated hypertensive response in treadmill exercise testing. J Clin Hypertens (Greenwich) 2024; 26:687-695. [PMID: 38605567 PMCID: PMC11180695 DOI: 10.1111/jch.14814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Early determination of changes in myocardial functions is essential for the protection of cardiovascular diseases. This study aimed to evaluate myocardial work parameters in healthy individuals who developed an exaggerated hypertensive response during the treadmill exercise test procedure. The study included a total of 64 patients for whom an exercise electrocardiography test was planned for functional capacity evaluation. The study population was divided according to the presence of exaggerated hypertensive response to exercise (EBPRE) (SBP/DBP ≥210/105 mmHg in males ≥190/105 mmHg in females) and normal blood pressure response to exercise (NBPRE). Patients' echocardiographic evaluations were made at rest, and myocardial work parameters were calculated. There was no statistical difference between the groups (NBPRE vs. EBPRE, respectively) in terms of left ventricular 2,3 and 4 chamber strains and global longitudinal strain (GLS) values (-20.6 ± -2.3, -19.7 ± -1.9, p:.13; -21.3 ± -2.7, -21 ± -2.4, p:.68; -21.2 ± -2.2, -21.2 ± -2.3, p:.93; and -20.8 ± -1.5, -20.4 ± -1.5, p:.23, respectively). Global constrictive work (GCW), global waste work (GWW), and global work efficiency (GWE) were not statistically different between the two groups (2374 ± 210, 2465 ± 204, p:.10; 142 ± 64, 127 ± 42, p:.31; 94.3 ± 2.5, 95.1 ± 1.5, p:.18, respectively). In contrast, global work index (GWI) parameters were different between the two groups (2036 ± 149, 2147 ± 150, p < .001). The GWI was independently associated with EBPRE (odds ratio with 95% 3.32 (1.02-11.24), p = .03). The partial effect plots were used for GWI to predict EBPRE, according to the results, an increase in GWI predicts probability of exaggerated hypertensive response. In conclusion, Myocardial work analyses might be used to identify early signs of myocardial involvement in normotensive patients with EBPRE.
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Affiliation(s)
- Süleyman Cagan Efe
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Mahmut Buğrahan Cicek
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Tuba Unkun
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Enver Yucel
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Ali Karagöz
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Cem Doğan
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Zübeyde Bayram
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Ali Furkan Tekatlı
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Baver Bozan
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Murat Karaçam
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Gülümser Sevgin Halil
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Turgut Karabağ
- Department of CardiologyIstanbul Education and Research HospitalIstanbulTurkey
| | - Cihangir Kaymaz
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Nihal Ozdemir
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
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Ran H, Ma XW, Wan LL, Ren JY, Zhang JX, Zhang PY, Schneider M. Myocardial Work Measurement With Functional Capacity Evaluation in Primary Systemic Hypertension Patients: Comparison Between Left Ventricle With and Without Hypertrophy. J Thorac Imaging 2024; 39:137-145. [PMID: 36469699 PMCID: PMC11027989 DOI: 10.1097/rti.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Noninvasive measurement of myocardial work (MW) incorporates left ventricular (LV) pressure, and, therefore, allows correction of global longitudinal strain for changing afterload conditions. We sought to investigate MW as a tool to detect early signs of LV dysfunction in primary systemic hypertension patients, particularly with different predictive indices. METHODS AND RESULTS None left ventricular hypertrophy (NLVH) and left ventricular hypertrophy (LVH) patients established were all primary systemic hypertension with preserved ejection fraction. Forty in NLVH and forty in LVH according to left ventricular end-diastolic mass index (LVEDmassI) were prospectively enrolled. The following indices of MW were assessed: global work index, global constructive work, global wasted work (GWW), and global work efficiency (GWE). Both global work index ( P =0.348) and global constructive work ( P =0.225) were increased in NLVH and decreased in LVH, and GWW ( P <0.001) was increased significantly in NLVH and increased more in LVH, while GWE ( P <0.001) was decreased significantly in NLVH and decreased more in LVH. The clinical utility of GWW (95% CI: 0.802-0.951) and GWE (95% CI: 0.811-0.950) were verified by receiver-operating characteristic curve analysis showing larger net benefits as evaluated with LVH and control comparisons. In multivariate linear regression analysis, 4-dimenaional LVEDmassI was independently associated with GWE ( P =0.018) in systemic hypertension patients. Assessment of intraobserver and interobserver variability in the MW echocardiographic data documented good interclass correlation coefficients (all >0.85). CONCLUSION GWW and GWE derived from MW are more accurate, sensitive, and reproducible predictors to detect early LV dysfunction in primary systemic hypertension patients, especially in distinguishing the potential functional abnormality of NLVH and LVH, even though the ejection fraction is preserved.
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Affiliation(s)
- Hong Ran
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiao-wu Ma
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin-lin Wan
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun-yi Ren
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian-xin Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping-yang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité-Universitaetsmedizin, Berlin, Germany
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Frișan AC, Mornoș C, Lazăr MA, Șoșdean R, Crișan S, Ionac I, Luca CT. Echocardiographic Myocardial Work: A Novel Method to Assess Left Ventricular Function in Patients with Coronary Artery Disease and Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:199. [PMID: 38399487 PMCID: PMC10890444 DOI: 10.3390/medicina60020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Myocardial ischemia caused by coronary artery disease (CAD) and the presence of metabolic abnormalities and microvascular impairments detected in patients with diabetes mellitus (DM) are a common cause of left ventricular (LV) dysfunction. Transthoracic echocardiography is the most-used, non-invasive imaging method for the assessment of myocardial contractility. The accurate evaluation of LV function is crucial for identifying patients who are at high risk or may have worse outcomes. Myocardial work (MW) is emerging as an alternative tool for the evaluation of LV systolic function, providing additional information on cardiac performance when compared to conventional parameters such as left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) because it incorporates deformation and load into its analysis. The potential of MW in various conditions is promising and it has gained increased attention. However, larger studies are necessary to further investigate its role and application before giving an answer to the question of whether it can have widespread implementation into clinical practice. The aim of this review is to summarize the actual knowledge of MW for the analysis of LV dysfunction caused by myocardial ischemia and hyperglycemia.
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Affiliation(s)
- Alexandra-Cătălina Frișan
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristian Mornoș
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Mihai-Andrei Lazăr
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Raluca Șoșdean
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Simina Crișan
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Ioana Ionac
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Nordlund D, Lav T, Jablonowski R, Khoshnood A, Ekelund U, Atar D, Erlinge D, Engblom H, Arheden H. Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data. Clin Cardiol 2024; 47:e24216. [PMID: 38269628 PMCID: PMC10790509 DOI: 10.1002/clc.24216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea ) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). METHODS A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2-6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax ) reflecting contractility, Ea , ventriculoarterial coupling (Ea /Emax ), SW, potential energy, external power, energy per ejected volume, and efficiency. RESULTS All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax : 1.34 ± 0.48 versus 1.50 ± 0.41 mmHg/mL, p = .024), ventriculoarterial coupling (Ea /Emax : 1.27 ± 0.61 versus 0.73 ± 0.17, p < .001) and SW (0.96 ± 0.32 versus 1.38 ± 0.32 J, p < .001). These variables correlated to both MaR and IS (Emax : r2 = 0.25 and r2 = 0.29; Ea /Emax : r2 = 0.36 and r2 = 0.41; SW: r2 = 0.21 and r2 = 0.25). CONCLUSIONS Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW.
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Affiliation(s)
- David Nordlund
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Theodor Lav
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Robert Jablonowski
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Ardavan Khoshnood
- Department of Clinical Sciences Malmö, Emergency Medicine, Lund UniversitySkane University HospitalMalmöSweden
| | - Ulf Ekelund
- Department of Clinical Sciences Lund, Emergency MedicineLund University and Skane University HospitalLundSweden
| | - Dan Atar
- Dept. of CardiologyOslo University Hospital UllevalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - David Erlinge
- Cardiology, Department of Clinical Sciences LundLund University and Skane University HospitalLundSweden
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
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Dell'Angela L, Nicolosi GL. From ejection fraction, to myocardial strain, and myocardial work in echocardiography: Clinical impact and controversies. Echocardiography 2024; 41:e15758. [PMID: 38284670 DOI: 10.1111/echo.15758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Enhancing an echocardiographic tool, aimed to detect even subtle left ventricular (LV) systolic function abnormalities, capable of obtaining both early diagnosis and risk prediction of heart disease, represents an ambitious, attractive, and arduous purpose in the modern era of cardiovascular imaging. Ideally, that tool should be simple, reliable, and reproducible, in order to be concretely applied in routine clinical practice. Importantly, that technique should be physiologically plausible and useful both at the population-level, as well as in the individual subject. For a long time, LV ejection fraction (EF) has been considered the first-line parameter for assessing LV global systolic function, strictly related to the prognosis, at least in some settings. However, LV EF limitations are well-known, even though frequently overemphasized, including its load-dependency. Therefore, myocardial strain techniques have been proposed, deemed able to disclose even subtle early LV function anomalies. Nevertheless, many disadvantages of myocardial strain have been reported as well. More recently, myocardial work (MW) analysis has been introduced as a new echocardiographic tool for the evaluation of LV global systolic function, attempting to overcome EF and strain disadvantages. However, MW has shown many limits as well. Notwithstanding, LV EF still remains a landmark functional classification marker for heart failure and cardiac oncology, allowing reliable fast reassessment of LV function changes during patient management, in order to guide treatment in individual cases as well. Notably, global longitudinal strain and MW parameters seem to show better meaningful results at the population-level, but controversial clinical impact, major limitations, wide cut-offs spread and overlap, when the single value needs to be applied to the single case. Taking into account the recent literature-based evidence, the scope of the present narrative critical review is trying to delineate the different types of information given by the described LV global systolic function parameters, both at the population-level and in the individual case, in order to trace a comparative analysis of advantages and limitations in clinical practice.
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Affiliation(s)
- Luca Dell'Angela
- Cardio-Thoracic and Vascular Department, Cardiology Division, Gorizia & Monfalcone Hospital, ASUGI, Gorizia, Italy
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7
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Moya A, Buytaert D, Penicka M, Bartunek J, Vanderheyden M. State-of-the-Art: Noninvasive Assessment of Left Ventricular Function Through Myocardial Work. J Am Soc Echocardiogr 2023; 36:1027-1042. [PMID: 37437670 DOI: 10.1016/j.echo.2023.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
The assessment of myocardial work (MW) using noninvasive pressure-strain loop analysis is a novel echocardiographic method that provides a more precise assessment of cardiac performance by considering the left ventricular loading condition. By integrating various MW components such as index, efficiency, and constructive and wasted work, an extensive analysis of left ventricular mechanics and energetics can be achieved. This approach offers a more comprehensive assessment of global cardiac function and performance, surpassing conventional surrogate indices. In this review, we aim to summarize the existing knowledge on MW and its distinctive characteristics in various cardiac pathologies.
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Affiliation(s)
- Ana Moya
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; CardioPath PhD Program, Department of Advanced Biomedical Sciences, Cardiovascular Pathophysiology and Therapeutics, University of Naples Federico II, Naples, Italy.
| | - Dimitri Buytaert
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
| | - Martin Penicka
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
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Sun S, Chen N, Sun Q, Wei H, Fu T, Shang Z, Sun Y, Cong T, Xia Y, Xie F, Porter TR. Association Between Segmental Noninvasive Myocardial Work and Microvascular Perfusion in ST-Segment Elevation Myocardial Infarction: Implications for Left Ventricular Functional Recovery and Clinical Outcomes. J Am Soc Echocardiogr 2023; 36:1055-1063. [PMID: 37225007 DOI: 10.1016/j.echo.2023.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Predicting left ventricular recovery (LVR) after acute ST-segment elevation myocardial infarction (STEMI) is of prognostic importance. This study aims to explore the prognostic implications of segmental noninvasive myocardial work (MW) and microvascular perfusion (MVP) after STEMI. METHODS In this retrospective study, 112 patients with STEMI who underwent primary percutaneous coronary intervention and transthoracic echocardiography after percutaneous coronary intervention were enrolled. Microvascular perfusion was analyzed by myocardial contrast echocardiography, and segmental MW was analyzed by noninvasive pressure-strain loops. A total of 671 segments with abnormal function at baseline were analyzed. The degrees of MVP were observed following intermittent high-mechanical index impulses: replenishment within 4 seconds (normal MVP), replenishment >4 seconds and within 10 seconds (delayed MVP), and persistent defect (microvascular obstruction). The correlation between MW and MVP was analyzed. The correlation of the MW and MVP with LVR (normalization of wall thickening, >25%) was assessed. The prognostic value of segmental MW and MVP for cardiac events (cardiac death, admission for congestive heart failure, or recurrent myocardial infarction) was evaluated. RESULTS Normal MVP was seen in 70 segments, delayed MVP in 236, and microvascular obstruction in 365. The segmental MW indices were independently correlated with MVP; 244 (36.4%) segments had segmental LVR at 3-month follow-up. Segmental MW efficiency and MVP were independently associated with segmental LVR (P < .05). The χ2 of combination of segmental MW efficiency and MVP was higher than either index alone for identifying segmental LVR (P < .001). At a median follow-up of 42.0 months, cardiac events occurred in 13 patients; all regional MW parameters, high sensitivity troponin I, regional longitudinal strain, and so on were associated with cardiac events. CONCLUSIONS Segmental MW indices are associated with MVP within the infarct zone following reperfused STEMI. Both are independently associated with segmental LVR, and regional MW is associated with cardiac events, providing prognostic value in STEMI patients.
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Affiliation(s)
- Siyao Sun
- Department of Cardiac Ultrasound, First Affiliated Hospital of Da Lian Medical University, Da Lian City, Liao Ning Province, People's Republic of China
| | - Na Chen
- Department of Cardiac Ultrasound, First Affiliated Hospital of Da Lian Medical University, Da Lian City, Liao Ning Province, People's Republic of China
| | - Qiaobing Sun
- Department of Cardiac Ultrasound, First Affiliated Hospital of Da Lian Medical University, Da Lian City, Liao Ning Province, People's Republic of China
| | - Hong Wei
- Department of Cardiac Ultrasound, First Affiliated Hospital of Da Lian Medical University, Da Lian City, Liao Ning Province, People's Republic of China
| | - Tingting Fu
- Department of Cardiac Ultrasound, First Affiliated Hospital of Da Lian Medical University, Da Lian City, Liao Ning Province, People's Republic of China
| | - Zhijuan Shang
- Department of Cardiac Ultrasound, First Affiliated Hospital of Da Lian Medical University, Da Lian City, Liao Ning Province, People's Republic of China
| | - Yinghui Sun
- Department of Cardiac Ultrasound, First Affiliated Hospital of Da Lian Medical University, Da Lian City, Liao Ning Province, People's Republic of China
| | - Tao Cong
- Department of Cardiac Ultrasound, First Affiliated Hospital of Da Lian Medical University, Da Lian City, Liao Ning Province, People's Republic of China.
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Da Lian Medical University, Da Lian City, Liao Ning Province, People's Republic of China
| | - Feng Xie
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Thomas R Porter
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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9
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Peters M, Jan MF, Ashraf M, Sanders H, Roemer S, Schweitzer M, Adefisoye J, Galazka P, Jain R, Jahangir A, Khandheria B, Tajik AJ. Myocardial Work in Apical Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2023; 36:1043-1054.e3. [PMID: 37406714 DOI: 10.1016/j.echo.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Pressure-strain loop analysis is a novel echocardiographic technique to calculate myocardial work indices that has not been applied to patients with apical hypertrophic cardiomyopathy (ApHCM). We hypothesized that myocardial work indices differ between patients with ApHCM and those with non-ApHCM. This study aimed to (1) evaluate myocardial work indices in patients with ApHCM compared with those with non-ApHCM, (2) describe associations with relevant clinical variables, and (3) examine associations with significant late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging. METHODS We retrospectively identified 48 patients with ApHCM and 69 with non-ApHCM who had measurements of global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. We evaluated available cardiac magnetic resonance imaging data on 34 patients with ApHCM and 51 with non-ApHCM. Multivariable regression models correcting for traditional cardiac risk factors were used to evaluate the associations of myocardial work indices with relevant clinical variables. RESULTS Median GLS (-11% vs -18%, P < .001), GWI (966 mm Hg% vs 1803 mm Hg%, P < .001), and GCW (1,050 mm Hg% vs 1,988 mm Hg%, P < .001) were significantly impaired in patients with ApHCM compared with those with non-ApHCM. Increasing N-terminal pro b-type natriuretic peptide, abnormal ultrasensitive troponin, and increasing maximal left ventricular wall thickness were significantly associated with reduced GWI and GCW in patients with ApHCM (P < .05). Global constructive work had only modest accuracy (area under the curve [AUC] = 0.70) to predict LGE in patients with ApHCM. However, in patients with non-ApHCM, GLS was the strongest predictor of LGE (AUC = 0.91), with a -17% cutoff yielding 81% sensitivity and 80% specificity. CONCLUSION Myocardial work indices are significantly impaired in patients with ApHCM compared to those with non-ApHCM and correlate with important clinical variables. Global longitudinal strain, GWI, and GCW are more strongly predictive of fibrosis in patients with non-ApHCM than ApHCM.
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Affiliation(s)
- Matthew Peters
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Muddasir Ashraf
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Heather Sanders
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - McKenzie Schweitzer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - James Adefisoye
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Patrycja Galazka
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Bijoy Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin.
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Chen HC, Liu WH, Chen YL, Lee WC, Fang YN, Chong SZ, Chen MC. Left bundle branch pacing preserved left ventricular myocardial work in patients with bradycardia. Front Cardiovasc Med 2023; 10:1201841. [PMID: 37781294 PMCID: PMC10539618 DOI: 10.3389/fcvm.2023.1201841] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023] Open
Abstract
Background Left bundle branch pacing (LBBP) is an emerging physiological pacing modality. Left ventricular (LV) myocardial work (MW) incorporates afterload and LV global longitudinal strain to estimate global and segmental myocardial contractility. However, the effect of LBBP on LV MW remains unknown. This study aimed to evaluate the impact of LBBP on LV MW in patients receiving pacemaker for bradyarrhythmia. Methods We prospectively enrolled 70 bradycardia patients with normal LV systolic function receiving LBBP (n = 46) and non-selective His-bundle pacing (NS-HBP) (n = 24). For comparative analysis, patients receiving right ventricular pacing (RVP) (n = 16) and control subjects (n = 10) were enrolled. Two-dimensional speckle tracking echocardiography was performed. The LV pressure-strain loop was non-invasively constructed to assess global LV MW. Results After 6-month follow-up, LBBP group (with >40% ventricular pacing during 6 months) had shorter peak strain dispersion (PSD) compared with RVP group, and higher LV global longitudinal strain compared with RVP group and NS-HBP group, but had no difference in left intraventricular mechanical dyssynchrony, including septal-to-posterior wall motion delay and PSD, compared with NS-HBP group. During ventricular pacing, LBBP group had higher global MW index (GWI) (2,189 ± 527 vs. 1,493 ± 799 mmHg%, P = 0.002), higher global constructive work (GCW) (2,921 ± 771 vs. 2,203 ± 866 mmHg%, P = 0.009), lower global wasted work (GWW) (211 ± 161 vs. 484 ± 281 mmHg%, P < 0.001) and higher global MW efficiency (GWE) (91.4 ± 5.0 vs. 80.9 ± 8.3%, P < 0.001) compared with RVP group, and had lower GWW (211 ± 161 vs. 406 ± 234 mmHg%, P < 0.001) and higher GWE (91.4 ± 5.0 vs. 86.4 ± 8.1%, P < 0.001) compared with NS-HBP group. Conclusions In this study we found that in patients with mid-term (6-month) high ventricular pacing burden (>40%), LBBP preserved more LV MW compared with NS-HBP and RVP. Further studies are warranted to assess the association between LV MW and long-term clinical outcomes in LBBP with high ventricular pacing burden.
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Affiliation(s)
- Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Wen-Hao Liu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Wei-Chieh Lee
- Division of Cardiovascular Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yen-Nan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Shaur-Zheng Chong
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
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11
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Stendahl JC, Liu Z, Boutagy NE, Parajuli N, Lu A, Alkhalil I, Lin BA, Duncan JS, Sinusas AJ. Multiaxial pressure-strain analysis of regional myocardial work in the setting of graded coronary stenoses and dobutamine stress. Am J Physiol Heart Circ Physiol 2023; 325:H492-H509. [PMID: 37417870 PMCID: PMC10538990 DOI: 10.1152/ajpheart.00735.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
We present a detailed analysis of regional myocardial blood flow and work to better understand the effects of coronary stenoses and low-dose dobutamine stress. Our analysis is based on a unique open-chest model in anesthetized canines that features invasive hemodynamic monitoring, microsphere-based blood flow analysis, and an extensive three-dimensional (3-D) sonomicrometer array that provides multiaxial deformational assessments in the ischemic, border, and remote vascular territories. We use this model to construct regional pressure-strain loops for each territory and quantify the loop subcomponent areas that reflect myocardial work contributing to the ejection of blood and wasted work that does not. We demonstrate that reductions in coronary blood flow markedly alter the shapes and temporal relationships of pressure-strain loops, as well as the magnitudes of their total and subcomponent areas. Specifically, we show that moderate stenoses in the mid-left anterior descending coronary artery decrease regional midventricle myocardial work indices and substantially increase indices of wasted work. In the midventricle, these effects are most pronounced along the radial and longitudinal axes, with more modest effects along the circumferential axis. We further demonstrate that low-dose dobutamine can help to restore or even improve function, but often at the cost of increased wasted work. This detailed, multiaxial analysis provides unique insight into the physiology and mechanics of the heart in the presence of ischemia and low-dose dobutamine, with potential implications in many areas, including the detection and characterization of ischemic heart disease and the use of inotropic support for low cardiac output.NEW & NOTEWORTHY Our unique experimental model assesses cardiac pressure-strain relationships along multiple axes in multiple regions. We demonstrate that moderate coronary stenoses decrease regional myocardial work and increase wasted work and that low-dose dobutamine can help to restore myocardial function, but often with further increases in wasted work. Our findings highlight the significant directional variation of cardiac mechanics and demonstrate potential advantages of pressure-strain analyses over traditional, purely deformational measures, especially in characterizing physiological changes related to dobutamine.
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Affiliation(s)
- John C Stendahl
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Zhao Liu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nabil E Boutagy
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut, United States
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nripesh Parajuli
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
| | - Allen Lu
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
| | - Imran Alkhalil
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Ben A Lin
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
| | - James S Duncan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
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12
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Huang H, Ruan Q, You Z, Fu L. Segmental and global myocardial work in hypertensive patients with different left ventricular ejection fraction: what's the role of the apex played? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1505-1514. [PMID: 37258991 DOI: 10.1007/s10554-023-02874-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/13/2023] [Indexed: 06/02/2023]
Abstract
We investigated myocardial work in hypertension (HT) among patients with different left ventricular ejection fraction (LVEF) to analyze the contribution of segmental myocardial work to global myocardial work. 114 patients with HT were divided into 4 groups: HTsnEF ("supra-normal" EF, > 65%); HTnEF ("normal" EF, 60-65%); HTmEF (designed as "middle" EF, 50-60%, within an abnormal LV geometry); HTrEF (reduced EF, < 50%). Longitudinal strain (LS) and myocardial work indices were obtained by echocardiography: myocardial work index (MWI), constructive work (MCW), wasted work (MWW), myocardial work efficiency (MWE), and percentages of apical work were calculated (PApi-MWI, PApi-MCW). Global LS (GLS) and global MWE (GWE) decreased in HTmEF and HTrEF groups. Global MWI(GWI) and MCW(GCW) increased in HTsnEF and HTnEF groups, and subsequently decreased, particularly in HTrEF group (P < 0.05). GWW increased in all HT subgroups. All segmental MWI and MCW were elevated or preserved initially in HTsnEF and HTnEF groups, and subsequently decreased, obviously in basal and middle segments in HTrEF group (P < 0.05). All segmental MWW increased and MWE decreased in HTmEF and HTrEF groups (P < 0.05). PApi-MWI and PApi-MCW increased initially, and subsequently decreased in HTmEF group, and elevated significantly in HTrEF group. Correlation analysis revealed a close connection of GLS and myocardial work parameters with LVEF. Apical myocardial work increased at the early stages of hypertensive systolic dysfunction, as a compensatory mechanism. Segmental myocardial work analysis added value to explore the distribution of myocardial impairment.
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Affiliation(s)
- Huimei Huang
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Ultrasound, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China
| | - Qinyun Ruan
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
- Department of Ultrasound, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China.
| | - Ziling You
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Ultrasound, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China
| | - Liyun Fu
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Ultrasound, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China
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Uwase E, Caru M, Curnier D, Abasq Meng M, Andelfinger G, Krajinovic M, Laverdière C, Sinnett D, Périé D. Cardiac Mechanical Performance Assessment at Different Levels of Exercise in Childhood Acute Lymphoblastic Leukemia Survivors. J Pediatr Hematol Oncol 2023; 45:247-255. [PMID: 37278566 DOI: 10.1097/mph.0000000000002682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/31/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a shortage of relevant studies interested in cardiac mechanical performance. Thus, it is clinically relevant to study the impact of cancer treatments on survivors' cardiac mechanical performance to improve our knowledge. The first objective of this study is to assess survivors' cardiac mechanical performance during a cardiopulmonary exercise test (CPET) using both ventricular-arterial coupling (VAC) and cardiac work efficiency (CWE) from cardiac magnetic resonance (CMR) acquisitions. The second objective is to assess the impact of doxorubicin and dexrazoxane (DEX) treatments. METHODS A total of 63 childhood acute lymphoblastic leukemia survivors underwent a CMR at rest on a 3T magnetic resonance imaging system, followed by a CPET on ergocycle. The CircAdapt model was used to study cardiac mechanical performance. At different levels of exercise, arterial elastance, end-systolic elastance, VAC, and CWE were estimated. RESULTS We observed significant differences between the different levels of exercise for both VAC ( P <0.0001) and CWE parameters ( P =0.001). No significant differences were reported between prognostic risk groups at rest and during the CPET. Nevertheless, we observed that survivors in the SR group had a VAC value slightly lower than heart rate (HR)+DEX and HR groups throughout the CPET. Moreover, survivors in the SR group had a CWE parameter slightly higher than HR+DEX and HR groups throughout the CPET. CONCLUSIONS This study reveals that the combination of CPET, CMR acquisitions and CircAdapt model was sensitive enough to observe slight changes in the assessment of VAC and CWE parameters. Our study contributes to improving survivors' follow-up and detection of cardiac problems induced by doxorubicin-related cardiotoxicity.
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Affiliation(s)
- Egidie Uwase
- Department of Mechanical Engineering, Polytechnique
| | - Maxime Caru
- Department of Mechanical Engineering, Polytechnique
- Sainte-Justine University Health Center, Research Center
| | - Daniel Curnier
- Sainte-Justine University Health Center, Research Center
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Gregor Andelfinger
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Maja Krajinovic
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Delphine Périé
- Department of Mechanical Engineering, Polytechnique
- Sainte-Justine University Health Center, Research Center
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14
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Huang H, Fu L, Ruan Q, You Z, Yan L. Segmental and global myocardial work in hypertensive patients with different left ventricular geometry. Cardiovasc Ultrasound 2023; 21:11. [PMID: 37370171 DOI: 10.1186/s12947-023-00310-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Myocardial work acquired by echocardiography has emerged as a novel method to evaluate myocardial function. We investigated global and segmental myocardial work in hypertension (HT) among patients with different patterns of left ventricular (LV) geometry in order to analyze the contribution of segmental myocardial work to global myocardial work. METHODS AND RESULTS One hundred twenty-five patients with HT were divided into 4 groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). Longitudinal strain (LS) and the following indices were obtained by echocardiography: myocardial work index (MWI), myocardial constructive work (MCW), myocardial wasted work (MWW), and myocardial work efficiency (MWE). The global longitudinal strain (GLS) decreased gradually among the groups: NG, CR, CH and EH (P < 0.001). Global MWI (GWI) and global MCW (GCW) did not change across the different LV remodeling groups. Global MWW (GWW) increased and global MWE (GWE) decreased in both CH and EH group (P < 0.001). The LS of basal and middle regions reduced gradually in all HT subgroups, while apical LS decreased only in the CH and EH groups (P < 0.001). Basal MWI and MCW decreased in the CH and EH groups (P = 0.025, 0.007, respectively). Apical MWI and MCW increased in the NG and CR groups (P = 0.015, 0.044, respectively), with a decreasing trend in the CH and EH groups. All segmental MWW elevated and MWE reduced significantly in the CH and EH groups (P < 0.001). Univariate and multivariate logistic regression analyses demonstrated a significant association between left atrial volume index (LAVI), GLS, GWE and LV hypertrophy. At the receiver operating characteristic (ROC) analysis, optimal cutoff values of GLS, Apical LS, GWE and Apical MWE discriminating LV hypertrophy were 0.9072, 0.8049, 0.8325 and 0.7414, respectively. CONCLUSION Apical myocardial work increases in the early stages of LV remodeling, likely as a compensatory mechanism to maintain normal global myocardial work. Segmental myocardial work analysis offers a reliable means to explore the distribution of myocardial impairment in hypertensive patients at different LV remodeling stages.
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Affiliation(s)
- Huimei Huang
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Liyun Fu
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Qinyun Ruan
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China.
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
| | - Ziling You
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Lei Yan
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
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15
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Guo Y, Wang X, Yang CG, Meng XY, Li Y, Xia CX, Xu T, Weng SX, Zhong Y, Zhang RS, Wang F. Noninvasive assessment of myocardial work during left ventricular isovolumic relaxation in patients with diastolic dysfunction. BMC Cardiovasc Disord 2023; 23:129. [PMID: 36899310 PMCID: PMC9999647 DOI: 10.1186/s12872-023-03156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND This study aims to investigate the value of myocardial work (MW) parameters during the isovolumic relaxation (IVR) period in patients with left ventricular diastolic dysfunction (LVDD). METHODS This study prospectively recruited 448 patients with risks for LVDD and 95 healthy subjects. An additional 42 patients with invasive measurements of left ventricular (LV) diastolic function were prospectively included. The MW parameters during IVR were noninvasively measured using EchoPAC. RESULTS The total myocardial work during IVR (MWIVR), myocardial constructive work during IVR (MCWIVR), myocardial wasted work during IVR (MWWIVR), and myocardial work efficiency during IVR (MWEIVR) of these patients were 122.5 ± 60.1 mmHg%, 85.7 ± 47.8 mmHg%, 36.7 ± 30.6 mmHg%, and 69.4 ± 17.8%, respectively. The MW during IVR was significantly different between patients and healthy subjects. For patients, MWEIVR and MCWIVR were significantly correlated with the LV E/e' ratio and left atrial volume index, MWEIVR exhibited a significant correlation with the maximal rate of decrease in LV pressure (dp/dt per min) and tau, and the MWEIVR corrected by IVRT also exhibited a significant correlation with tau. CONCLUSIONS MW during IVR significantly changes in patients with risks for LVDD, and is correlated to LV conventional diastolic indices, including dp/dt min and tau. Noninvasive MW during IVR may be a promising tool to evaluate the LV diastolic function.
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Affiliation(s)
- Ying Guo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - Xiang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - Chen-Guang Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - Xu-Yang Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - Yi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - Chen-Xi Xia
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - Tao Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - Si-Xian Weng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - You Zhong
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - Rui-Sheng Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Beijing, P.R. China.
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Mihalcea D, Memis H, Balinisteanu A, Vladareanu AM, Mihaila S, Vinereanu D. Myocardial work-A new tool for early detection of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone chemotherapy induced-cardiotoxicity in hematological patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:377-384. [PMID: 36331055 DOI: 10.1002/jcu.23388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (RCHOP) chemotherapy in non-Hodgkin's lymphoma (NHL) has risk of cardiotoxicity. PURPOSE To determine the role of myocardial work and biomarkers in subclinical diagnosis and prediction of cardiotoxicity. METHODS The 130 NHL patients (52 ± 9 years, 62% men) scheduled for RCHOP, with LVEF>50%, were evaluated at baseline, after third cycle and chemotherapy completion for 3D LVEF, 2D myocardial deformation (longitudinal, radial, circumferential strain - LS, RS, CS) and myocardial work (global constructive work, waste work, work index and work efficiency - GCW, GWW, GWI, GWE). NT-pro-BNP and troponin I were determined. RESULTS After chemotherapy ended, 37 patients (28%) (group I) developed asymptomatic cardiotoxicity (8 mild form, 25 moderate form, 4 severe form); 93 patients (group II) did not. After third cycle, all patients had decreased LS, CS, RS, GCW, GWI, GWE and increased GWW, persistent after chemotherapy completion, with significant changes in group I. After third cycle, GWE and GCW were the best independent predictors for LVEF reduction; GWE decrease with>5% after third cycle predicted cardiotoxicity after chemotherapy completed (91% sensitivity, 94% specificity). CONCLUSIONS In NHL, myocardial work can diagnose subclinical cardiotoxicity and predict LVEF decline. These parameters should be used for sensitive evaluation of myocardial function during chemotherapy.
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Affiliation(s)
- Diana Mihalcea
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania
| | - Hayat Memis
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania
| | - Anca Balinisteanu
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania
| | - Ana-Maria Vladareanu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania
| | - Sorina Mihaila
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania
| | - Dragos Vinereanu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania
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17
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Gao L, Wang Y, Gao M, Chen L. Clinical research progress of myocardial work in assessment and prediction of coronary artery disease in noninvasive pressure-strain loop technique. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:38-45. [PMID: 36069389 DOI: 10.1002/jcu.23326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Early identification and treatment of high-risk coronary artery disease (CAD) is the main goal of current cardiovascular disease treatments. Speckle-tracking ultrasound technology can quantify myocardial work using pressure-strain loops. Because myocardial work takes into account the effect of the left ventricular systolic function afterload, it can more objectively reflect left ventricular myocardial mechanical function than the overall left ventricular longitudinal strain. Therefore, this technique is more widely used in diseases caused by CAD. This article reviews the evaluation and prediction of different CAD types using a variety of myocardial work parameters and provides a new method for clinical research to assess myocardial function, which is expected to become a new prediction method for CAD.
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Affiliation(s)
- Lu Gao
- Department of the Cardiovascular Center, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Yinghui Wang
- Department of the Cardiovascular Center, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Ming Gao
- Department of the Cardiovascular Center, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Liping Chen
- Department of Echocardiography, Cardiovascular Disease Center, The First Hospital of Jilin University, Changchun, People's Republic of China
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Oberhoffer FS, Li P, Jakob A, Dalla-Pozza R, Haas NA, Mandilaras G. Energy Drinks Decrease Left Ventricular Efficiency in Healthy Children and Teenagers: A Randomized Trial. SENSORS (BASEL, SWITZERLAND) 2022; 22:7209. [PMID: 36236307 PMCID: PMC9572576 DOI: 10.3390/s22197209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Background: Minors are considered the main consumer group of energy drinks (EDs). The aim of this study was to investigate the acute effects of ED consumption on left ventricular (LV) hemodynamics and efficiency in healthy children and teenagers. Methods: This study was a randomized, single-blind, placebo-controlled, crossover clinical trial. Study participants consumed a weight-adjusted amount of an ED or a placebo on two consecutive days. LV hemodynamics and efficiency parameters were evaluated non-invasively by generating LV pressure−volume loops (PVLs) through simultaneous echocardiography and blood pressure measurement. Results: A total of 24 children and teenagers (14.90 ± 2.27 years, 13 male) were included in the present study. Conventional echocardiographic parameters of LV function did not show significant differences between both beverage groups. The non-invasive generation of LV PVLs revealed a significantly lower cardiac efficiency 240 min after the ED consumption compared to the placebo intake (140.72 (133.21−149.73) mmHg vs. 135.60 (124.78−140.33) mmHg, p < 0.01). Conclusions: Acute ED consumption is associated with a significantly lower cardiac efficiency in healthy minors. The generation of non-invasive LV PVLs might be beneficial in the assessment of subtle changes in LV efficiency. Further studies need to investigate the influence of chronic ED consumption on LV function and morphology.
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Li X, Zhang P, Li M, Zhang M. Myocardial work: the analytical methodology and clinical utilities. Hellenic J Cardiol 2022; 68:46-59. [PMID: 35931412 DOI: 10.1016/j.hjc.2022.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/03/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022] Open
Abstract
The evaluation of left ventricular (LV) systolic function is an essential part of the clinical practice of cardiology. Although left ventricular ejection fraction (LVEF) is the most validated and widely used parameter, it has fundamental limitations. LV strain is more sensitive to detect subtle myocardial dysfunction when LVEF was preserved, but it is load-dependent. Invasive left ventricular pressure-volume loop (LV-PVL) is the reliable standard to evaluate cardiac function, but its wide clinical application is limited by the risk of invasive LV pressure detection. Until the advent of non-invasive LV pressure-strain loop (LV-PSL), things have changed. LV-PSL is in good agreement with regional myocardial oxygen consumption and metabolism. Compared with traditional echocardiographic parameters or LV strain, myocardial work (MW) derived from LV-PSL is a more advanced tool that combines deformation as well as hemodynamics through integration of global longitudinal strain and non-invasive LV systolic pressure. In recent years, researches on MW are going on in full swing and show many advantages of MW. This review described the method and discussed the applications, advantages, limitations, and prospects of MW in multiple cardiovascular diseases. The goal is to provide the readers new insights for evaluating LV systolic function and promote the incorporation of MW into daily practice.
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Affiliation(s)
- Xinhao Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China
| | - Pengfei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China.
| | - Mengmeng Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China.
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China.
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Zhao Q, Cui C, Li Y, Liu Y, Huang D, Wang Y, Hu Y, Liu R, Zhu H, Liu L. Evaluation of myocardial work in patients with hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy based on non-invasive pressure-strain loops. Front Cardiovasc Med 2022; 9:767875. [PMID: 35958393 PMCID: PMC9360312 DOI: 10.3389/fcvm.2022.767875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background The capacity to distinguish hypertrophic cardiomyopathy (HCM) from hypertensive left ventricular hypertrophy (H-LVH) based on morphological features obtained by conventional echocardiography is limited. We investigated the global myocardial work of the left ventricle in two types of hypertrophies using the non-invasive myocardial work index (NMWI). Methods Conventional echocardiography was performed on 107 subjects with preserved left ventricular ejection fraction (LVEF ≥ 50%), who comprised patients with HCM (n = 40), H-LVH (n = 35), and healthy people with normal blood pressure and left ventricular structure (n = 32). Except for the conventional echocardiographic parameters, the left ventricular myocardial work parameters based on pressure-strain loops, including global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were evaluated in three groups. Multivariate discriminant analysis and receiver operating characteristic (ROC) curve were used to evaluate the incremental value of NMWI for distinguishing HCM from H-LVH. Results Compared to the control group, GWI and GCW were significantly lower in HCM patients (P < 0.05), whereas GWI was significantly higher in H-LVH patients. GWW was higher and GWE was significantly decreased in both HCM and H-LVH patients than in the control group (P < 0.05). Multivariate discriminant analysis and ROC curve revealed that the inter-ventricular septum thickness (IVST)/left ventricular posterior wall thickness (LVPWT) and GCW were each able to distinguish HCM from H-LVH. The combination of IVST/LVPWT and GCW discriminated HCM and H-LVH with a higher predictive accuracy of 94.7%. Conclusion NMWI may provide additional information in evaluating the myocardial function in patients with HCM and H-LVH. Myocardial work combined with conventional echocardiography could improve the clinical diagnostic accuracy of distinguishing HCM and H-LVH.
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Zhao K, Liu Y, Dong L, Gao B. Echocardiographic myocardial work in pre-adolescent male basketball players: a comparison with cardiopulmonary exercise test-derived aerobic capacity. Front Physiol 2022; 13:913623. [PMID: 35936902 PMCID: PMC9355256 DOI: 10.3389/fphys.2022.913623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Pressure-strain loop (PSL) analysis provides a novel, less load-dependent non-invasive method to quantify myocardial work and demonstrates a significant correlation with the contractile reserve in adult athletes. We aim to validate PSL-derived markers in characterizing LV function in pre-adolescent basketball players by comparing results before and after the cardiopulmonary exercise test (CPX) and explore its association with CPX-derived aerobic capacity.Methods: Cardiac morphology and function in 20 pre-adolescent basketball players were assessed at 9.7 years old (9.7 ± 1.1 year) before and after cardiopulmonary exercise testing. Echocardiography was performed in all subjects, including two-dimensional speckle-tracking echocardiography (STE). Simultaneous brachial-cuff-measured blood pressure was recorded to perform PSL analysis.Results: Nineteen subjects were included in the final analysis. Exercise training in pre-adolescent males was associated with lower global work index (GWI) and global work efficiency (GWE) at rest. GWE at stress was significantly correlated with VO2max and peak O2 pulse (p = 0.0122, r = 0.56; p = 0.00122, r = 0.69, respectively). When indexed by body mass, GWI and GWE both significantly correlated with relative VO2max (p = 0.0086 and 0.0011 respectively, r = 0.58 and 0.69 respectively); GWI and GWE at baseline and stress were all significantly correlated with peak O2 pulse (GWI at baseline, p< 0.0001, r = −0.90; GWE at baseline, p< 0.0001, r = −0.89; GWI at stress, p= 0.0289, r = −0.50; GWE at stress, p< 0.0001, r = −0.83).Conclusion: PSL-analysis-derived GWI and GWE at rest indexed by body mass are associated with cardiopulmonary exercise test-derived peak oxygen consumption and oxygen pulse in pre-adolescent athletes.
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Affiliation(s)
- Kewei Zhao
- High Performance Research Center, China Institute of Sport Science, Beijing, China
| | - Yu Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Lili Dong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- *Correspondence: Lili Dong, ; Binghong Gao,
| | - Binghong Gao
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China
- *Correspondence: Lili Dong, ; Binghong Gao,
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22
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Santoro C, Ilardi F, Esposito R, Mandoli GE, Canonico ME, Buongiorno F, Canciello G, Prastaro M, Losi MA, Esposito G. Impact of Age and Heart Rate on Strain-Derived Myocardial Work in a Population of Healthy Subjects. Diagnostics (Basel) 2022; 12:diagnostics12071697. [PMID: 35885601 PMCID: PMC9325020 DOI: 10.3390/diagnostics12071697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The influence of age and gender on strain-imaging-derived myocardial work (MW) was recently investigated in healthy subjects. No information is available on the impact of heart rate (HR) on MW. Methods: 177 healthy subjects (47% men, mean age 42 years) underwent an echo-Doppler exam, including quantification of global longitudinal strain (GLS). Cuff blood pressure was used as a surrogate of left ventricular peak pressure to estimate global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Statistical analyses were performed according to age and HR tertiles. Results: GWW was higher in the third HR tertile, i.e., ≥74 bpm (74.7 ± 33.6 mmHg %) than in the first HR tertile (<66 bpm) (61.0 ± 32.5 mmHg %) (p < 0.02). In the pooled population, by adjusting for systolic blood pressure, GLS, E/e’ ratio and left atrial volume index, age was independently associated with GCW (β = 0.748) and GWI (β = 0.685) (both p < 0.0001) and HR with GWW (β = 0.212, p = 0.006) and GWE (β = −0.204, p = 0.007). Conclusions: In healthy subjects age shows a mild influence on GCW. HR exerts an independent negative impact on GWW and GWE: the higher HR the greater wasted work and lower myocardial efficiency.
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Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
- Correspondence: ; Tel.: +39-081-746-3663
| | - Federica Ilardi
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy;
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy;
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Federica Buongiorno
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Grazia Canciello
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Maria Prastaro
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Maria-Angela Losi
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
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Li J, Luo H, Liu YY, Chen LX, Zhu MQ, Deng QT, Zhu DM, Wang ZM, Xu JF. Value of UGT2B7-161 Single Nucleotide Polymorphism in Predicting the Risk of Cardiotoxicity in HER-2 Positive Breast Cancer Patients Who Underwent Pertuzumab Combined with Trastuzumab Therapy by PSL. Pharmgenomics Pers Med 2022; 15:215-225. [PMID: 35321089 PMCID: PMC8935087 DOI: 10.2147/pgpm.s351718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To explore the value of uridine diphosphate-glucuronosyltransferase 2B7 (UGT2B7)-161 single nucleotide polymorphism in predicting the occurrence of cardiotoxicity in Chinese human epidermal growth factor 2 (HER-2) positive breast cancer patients who underwent pertuzumab combined with trastuzumab Therapy. Methods Fifty patients with HER-2 positive breast cancer who planned to receive trastuzumab and pertuzumab therapy for more than four cycles were enrolled in this study, and blood samples were collected. Thirty healthy volunteers of matching ages were selected as the control group. Myocardial parameters such as global work index, global effective work, and global wasted work were measured before treatment (M0) and at the end of four cycles of treatment month three (M3). Blood samples were collected from patients at the M0 stage, and polymorphisms of the UGT2B7-161 gene were detected to evaluate the predictive ability of different gene phenotypes on the myocardial drug toxicity injury. Results There were 35 myocardial work decreased events among 50 patients. There were 24 (47.3%), 15 (40.8%), and 11 (11.8%) patients carrying UGT2B7-161 CC, CT, and TT genotypes, respectively. The occurrence of myocardial work decreased was decreased in UGT2B7-161 TT and CT genotypes (12.5%) compared with CC genotype (41.7%) with statistical significance (P < 0.001). Multivariate logistic regression model analysis exhibited that UGT2B7-161 genotypes, body mass index, and cardiac troponin I were independent factors influencing the risk of cardiotoxicity. Conclusion UGT2B7-161 single nucleotide polymorphism is a potential predictive factor for cardiotoxicity in HER-2 positive breast cancer patients receiving trastuzumab and pertuzumab dual-targeted drug therapy.
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Affiliation(s)
- Jian Li
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People’s Republic of China
- Correspondence: Jian Li; Jin-Feng Xu, Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), No. 1077 of Dongmenbei Road, Luohu District, Shenzhen, 518020, People’s Republic of China, Tel +86 755 25533018, Fax +86 755 22945252, Email ;
| | - Hui Luo
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People’s Republic of China
| | - Ying-Ying Liu
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People’s Republic of China
| | - Li-Xin Chen
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People’s Republic of China
| | - Mei-Qin Zhu
- Department of Medical Oncology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People’s Republic of China
| | - Quan-Tong Deng
- Department of Medical Oncology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People’s Republic of China
| | - Dong-Mei Zhu
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People’s Republic of China
- Department of Ultrasound, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Zi-Mo Wang
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People’s Republic of China
| | - Jin-Feng Xu
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People’s Republic of China
- Correspondence: Jian Li; Jin-Feng Xu, Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), No. 1077 of Dongmenbei Road, Luohu District, Shenzhen, 518020, People’s Republic of China, Tel +86 755 25533018, Fax +86 755 22945252, Email ;
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Vaz Ferreira V, Mano TB, Cardoso I, Coutinho Cruz M, Moura Branco L, Almeida-Morais L, Timóteo A, Galrinho A, Castelo A, Garcia Brás P, Simão D, Sardinha M, Gonçalves A, Cruz Ferreira R. Myocardial Work Brings New Insights into Left Ventricular Remodelling in Cardio-Oncology Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052826. [PMID: 35270517 PMCID: PMC8910703 DOI: 10.3390/ijerph19052826] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
Abstract
Serial transthoracic echocardiographic (TTE) assessment of 2D left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are the gold standard screening methods for cancer therapeutics-related cardiac dysfunction (CTRCD). Non-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages to evaluate the impact of cardiotoxic treatments on heart function. We prospectively assessed breast cancer female patients undergoing cancer therapy through serial monitoring by 2D and 3D TTE. Patients were evaluated at T0, T1 and T2 (before, 4–6 and 12–14 months after starting therapy, respectively). Through PSL analysis, MW indices were calculated. A total of 122 patients, with a mean age of 54.7 years, who received treatment with anthracyclines (77.0%) and anti-HER2 (75.4%) were included. During a mean follow-up of 14.9 ± 9.3 months, LVEF and GLS were significantly diminished, and 29.5% developed CTRCD. All MW indices were significantly reduced at T1 compared with baseline and tended to return to baseline values at T2. Global work index and global work efficiency showed a more pronounced variation in patients with CTRCD. The presence of more than one cardiovascular risk factor, obesity and baseline left atrium volume were predictors of changes in MW parameters. In conclusion, breast cancer treatment was associated with LV systolic dysfunction as assessed by MW, with its peak at 4–6 months and a partial recovery afterwards. Assessment of myocardial deformation parameters allows a more detailed characterization of cardiac remodelling and could enhance patient screening and selection for cardioprotective therapeutics.
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Affiliation(s)
- Vera Vaz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
- Correspondence:
| | - Tania Branco Mano
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Isabel Cardoso
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Madalena Coutinho Cruz
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Luísa Moura Branco
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Luís Almeida-Morais
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Ana Timóteo
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Ana Galrinho
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Alexandra Castelo
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Pedro Garcia Brás
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Diana Simão
- Department of Oncology, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, 1169-050 Lisbon, Portugal; (D.S.); (M.S.)
| | - Mariana Sardinha
- Department of Oncology, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, 1169-050 Lisbon, Portugal; (D.S.); (M.S.)
| | - António Gonçalves
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
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Liao L, Shi B, Ding Z, Chen L, Dong F, Li J, Zhong Y, Xu J. Echocardiographic study of myocardial work in patients with type 2 diabetes mellitus. BMC Cardiovasc Disord 2022; 22:59. [PMID: 35172745 PMCID: PMC8851829 DOI: 10.1186/s12872-022-02482-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background A noninvasive left ventricular (LV) pressure-strain loop (PSL) provides a new method to quantify myocardial work (MW) by combining global longitudinal strain (GLS) and LV pressure, which exerts potential advantages over traditional GLS. We studied the LV PSL and MW in patients with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study included 201 subjects (54 healthy controls and 147 T2DM patients) who underwent complete two-dimensional echocardiography (2DE), including 2D speckle-tracking echocardiography (STE), as well as brachial artery pulse pressure measurement. The PSL was used to determine the global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) of all study participants. The association between T2DM and LV function was evaluated according to these MW indices. Results The GLS was significantly lower in the T2DM group than in the control group (P < 0.001), indicating that the LV myocardium had been damaged, although the LV ejection fraction (LVEF) was still normal. The GWI and GWE were decreased (P = 0.022) and the GWW was increased (P < 0.001) in diabetic patients compared with controls, but the GCW was comparable in the two groups (P = 0.160). In all diabetic patients, age, body mass index, systolic blood pressure, smoking history, and LVEF were correlated with GWI, GWW and GWE. Conclusions The use of LV PSL is a novel noninvasive technique that could help to depict the relationship between LV myocardial damage and MW in patients with T2DM.
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Affiliation(s)
- Lisi Liao
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Bobo Shi
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Zhimin Ding
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Lixin Chen
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jian Li
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Yulin Zhong
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China. .,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.
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26
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Timóteo AT, Branco LM, Galrinho A, Rio P, Sousa L, Ferreira RC. Impact of repaired aortic coarctation in left ventricular myocardial work. Rev Port Cardiol 2022; 41:299-307. [DOI: 10.1016/j.repc.2021.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/19/2020] [Accepted: 02/04/2021] [Indexed: 10/19/2022] Open
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27
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Liu Z, Zhang L, Liu M, Wang F, Xiong Y, Tang Z, Li Q, Lu Q, Liang S, Niu T, Huang H. Myocardial Injury in Multiple Myeloma Patients With Preserved Left Ventricular Ejection Fraction: Noninvasive Left Ventricular Pressure-Strain Myocardial Work. Front Cardiovasc Med 2022; 8:782580. [PMID: 35127857 PMCID: PMC8810812 DOI: 10.3389/fcvm.2021.782580] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/20/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Over one-half of patients with multiple myeloma (MM) die of heart failure or arrhythmia. Left ventricular ejection fraction (LVEF) is used to describe left ventricular systolic function. However, depressed LVEF means advanced stage of left ventricular dysfunction in patients with MM. Left ventricular pressure-strain-derived myocardial work (LVMW) is a novel and noninvasive method for evaluating LV function related to LV dynamic pressure load. MW is assessed by LV MW index (LVMWI), constructive work, wasted work, and LV MW efficiency (LVMWE). In this study, we aimed to investigate the value of LVMW in cardiac function assessment and clinical prognosis of MM patients with preserved LVEF. Methods A total of 72 subjects, including 40 untreated MM patients with preserved EF (including the thick wall and normal wall groups) and 32 non-MM patients, were enrolled in this study. Laboratory data and clinical history of all the patients were collected. All the patients underwent comprehensive echocardiographic examinations and then LVMWI and LVMWE were calculated. Moreover, cardiac adverse events (CAEs) were observed in MM patients treated with bortezomib-based therapy after 6 months and the prognostic value of MW was assessed. Results (1) LV myocardial global work index (GWI), myocardial global work efficiency (GWE), and global longitudinal strain (GLS) were lower in the thick wall group of patients with MM compared with the normal wall group and controls. Cardiac segmental analysis of LVMWI in patients with MM showed an apical sparing pattern; (2) The area under the curve (AUC) of GWE for judging the disease severity based on the Revised International Staging System (R-ISS) was 0.835 (95% CI: 0.684–0.933, p < 0.05); (3) GWE, LgdFLC, and arrhythmia were independent risk factors of CAEs. The AUC of GWE for predicting CAEs in MM patients treated with bortezomib-based therapy for 6 months follow-up was 0.896 (95% CI: 0.758–0.970, p < 0.05). Conclusion MM Patients with preserved EF had subclinical LV systolic dysfunction, which was worse in the thick wall group. LVMWI was presented as “apical sparing” in patients with MM. A lower LVGWE may have a predictive value for CAEs in patients with MM after 6 months of follow-up.
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Affiliation(s)
- Zhiyue Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fang Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanqiu Xiong
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuoqin Tang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuchen Lu
- Department of Ultrasound, Mianyang Central Hospital, Mianyang, China
| | - Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ting Niu
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- He Huang
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28
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Lin J, Gao L, He J, Liu M, Cai Y, Niu L, Zhao Y, Li X, Wang J, Wu W, Zhu Z, Wang H. Comparison of Myocardial Layer-Specific Strain and Global Myocardial Work Efficiency During Treadmill Exercise Stress in Detecting Significant Coronary Artery Disease. Front Cardiovasc Med 2022; 8:786943. [PMID: 35111825 PMCID: PMC8801497 DOI: 10.3389/fcvm.2021.786943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background Myocardial 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. Methods Eighty-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. Results Patients 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. Conclusions Both 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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Affiliation(s)
- Jingru Lin
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijian Gao
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia He
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyi Liu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqi Cai
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lili Niu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Zhao
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoni Li
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Weichun Wu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Weichun Wu
| | - Zhenhui Zhu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Zhenhui Zhu
| | - Hao Wang
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Hao Wang
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29
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Lembo M, Manzi MV, Mancusi C, Morisco C, Rao MAE, Cuocolo A, Izzo R, Trimarco B. Advanced imaging tools for evaluating cardiac morphological and functional impairment in hypertensive disease. J Hypertens 2022; 40:4-14. [PMID: 34582136 PMCID: PMC10871661 DOI: 10.1097/hjh.0000000000002967] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/19/2023]
Abstract
Arterial hypertension represents a systemic burden, and it is responsible of various morphological, functional and tissue modifications affecting the heart and the cardiovascular system. Advanced imaging techniques, such as speckle tracking and three-dimensional echocardiography, cardiac magnetic resonance, computed tomography and PET-computed tomography, are able to identify cardiovascular injury at different stages of arterial hypertension, from subclinical alterations and overt organ damage to possible complications related to pressure overload, thus giving a precious contribution for guiding timely and appropriate management and therapy, in order to improve diagnostic accuracy and prevent disease progression. The present review focuses on the peculiarity of different advanced imaging tools to provide information about different and multiple morphological and functional aspects involved in hypertensive cardiovascular injury. This evaluation emphasizes the usefulness of the emerging multiimaging approach for a comprehensive overview of arterial hypertension induced cardiovascular damage.
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Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
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30
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Li X, Liu Q, Bao W, Li M, Zhang Y, Wan X, Zhang M. Impact of blood pressure changes on myocardial work indices in hypertensive patients in a day. J Clin Hypertens (Greenwich) 2021; 24:3-14. [PMID: 34889503 PMCID: PMC8783328 DOI: 10.1111/jch.14379] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/01/2021] [Accepted: 09/14/2021] [Indexed: 02/02/2023]
Abstract
Evaluating left ventricular function through instantaneous left ventricular deformation parameters might not always be accurate for patients with high fluctuations in blood pressure value due to afterload dependence. Myocardial work (MW) is a more advanced tool that combines global myocardial longitudinal strain (GLS) with LV (left ventricular) systolic pressure. The purpose of this study was to investigate the effect of blood pressure changes on MW indices in the population with normal blood pressure and hypertension in a day. A total of 117 participants (34 control subjects and 83 hypertensive patients) underwent echocardiographic measurements at rest, twice a day. Simultaneously, the brachial blood pressure was also measured. LV pressure‐strain loop (PSL) was used to calculate global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). The differences in the GLS and MW indices between the groups were compared, and the correlation of blood pressure changes with the changes in GLS and MW indices were evaluated. Compared to the control group, the hypertensive group showed higher GWI, GCW, and GWW but lower GLS and GWE. Absolute changes in blood pressure, GLS, and MW indices in hypertensive patients were significantly higher than that of the control subjects. Blood pressure changes had significant univariate correlation with changes in GLS and MW indices. In conclusion, significant fluctuations in blood pressure could induce changes in MW indices to preserve left ventricular systolic function. Repeated assessment of MW indices is necessary for hypertensive patients with large blood pressure fluctuations.
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Affiliation(s)
- Xinhao Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Quande Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Wuyun Bao
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Mengmeng Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Yu Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Xiaoyu Wan
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
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31
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Truong VT, Vo HQ, Ngo TNM, Mazur J, Nguyen TTH, Pham TTM, Le TK, Phan H, Palmer C, Nagueh SF, Chung ES. Normal Ranges of Global Left Ventricular Myocardial Work Indices in Adults: A Meta-Analysis. J Am Soc Echocardiogr 2021; 35:369-377.e8. [PMID: 34800670 DOI: 10.1016/j.echo.2021.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent studies have demonstrated left ventricular myocardial work (MW) is incremental in diagnosis and prognostication when compared to left ventricular ejection fraction and myocardial strain. We performed a meta-analysis of normal ranges of non-invasive MW indices including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) and to determine confounder that may contribute to variance in reported values. METHODS Four databases including Pubmed, Scopus, Embase, and Cochrane Library were searched through January 2021 using the key terms "myocardial work", "global constructive work", "global wasted work", "global work index", "global work efficiency". Studies were included if the articles reported LV myocardial work using 2D transthoracic echocardiography in healthy normal subjects, either in control group or comprising of the entire study cohort. The weighted mean was estimated by using the random effect model with a 95% confidence interval. Heterogeneity across included studies was assessed using the I2 test. Funnel plot and Egger's regression test were used to assess potential publication bias RESULTS: The search yielded 476 articles. After abstract and full-text screening, we included 13 datasets with 1665 patients for the meta-analysis. The reported normal mean values of GWI and GCW among the studies were 2010 mmHg% (95% CI, 1907 to 2113), and 2278 mmHg% (95% CI, 2186 to 2369) respectively. The mean GWW was 80 mmHg% (95% CI, 73 to 87), and the mean GWE was 96.0% (95% CI, 96% to 96%). Furthermore, gender significantly contributed to variations in normal values of GWI, GWW, and GWE. No evidence of significant publication bias was observed. CONCLUSION In this meta-analysis, we provide echocardiographic reference ranges for non-invasive indices of MW. These normal values could be served as a reference for clinical and research use.
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Affiliation(s)
- Vien T Truong
- The Christ Hospital Health Network, Cincinnati, Ohio, USA; The Linder Research Center, Cincinnati, Ohio, USA.
| | - Ha Q Vo
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania
| | - Tam N M Ngo
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Jan Mazur
- The Ohio State University, Columbus, Ohio, USA
| | - Tuy T H Nguyen
- Heart Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam
| | - Thuy T M Pham
- Heart Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam
| | - Tuyen K Le
- Heart Institute, Ho Chi Minh City, Vietnam
| | - Hoang Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania
| | - Cassady Palmer
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Eugene S Chung
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
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32
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Zhu H, Guo Y, Wang X, Yang C, Li Y, Meng X, Pei Z, Zhang R, Zhong Y, Wang F. Myocardial Work by Speckle Tracking Echocardiography Accurately Assesses Left Ventricular Function of Coronary Artery Disease Patients. Front Cardiovasc Med 2021; 8:727389. [PMID: 34676251 PMCID: PMC8523819 DOI: 10.3389/fcvm.2021.727389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Myocardial work (MW) is a novel non-invasive method that uses speckle tracking echocardiography (STE) to assess left ventricular (LV) function. MW incorporates the global longitudinal strain and afterload conditions. Here we aimed to use MW to assess the LV function of patients with coronary artery disease (CAD) with or without heart failure (HF). Methods: We enrolled a total of 150 individuals (50 each) with CAD and a normal LV ejection fraction (LVEF), CAD with HF, and healthy controls. Patients were divided into the hypertension (HTN) and normal blood pressure (no HTN) subgroups. MW was determined from the pressure-strain loop using STE. The relationships between MW indices and conventional echocardiographic parameters were evaluated, and the MW indices were compared among groups. Results: Univariate and multivariate analyses showed that MW indices were strongly correlated with LVEF. The global work index (GWI) was increased in the CAD with normal LVEF subgroup with HTN vs. controls (1,922.3 ± 393.1 vs. 1,639.7 ± 204.6 mmHg%, p < 0.05) and decreased in CAD patients with HF (no HTN: 940.9 ± 380.6 vs. 1,639.7 ± 204.6 mmHg%, p < 0.05; HTN: 857.3 ± 369.3 vs. 1,639.7 ± 204.6 mmHg%, p < 0.05). Global waste work was increased in all CAD subgroups vs. controls. Global constructive work had the same tendency as GWI in patients with CAD. Global MW efficiency was decreased in all patients with CAD. Conclusion: MW using STE accurately quantifies LV function in patients with CAD. It offers additional information about LV function with respect to disease progression, particularly in CAD patients with a normal LVEF.
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Affiliation(s)
- Huolan Zhu
- Department of Gerontology, Shaanxi Provincial People's Hospital, Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Xi'an, China.,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Guo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chenguang Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School, Medical College of Peking University, Beijing, China
| | - Xuyang Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zuowei Pei
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ruisheng Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - You Zhong
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Huang D, Cui C, Zheng Q, Li Y, Liu Y, Hu Y, Wang Y, Liu R, Liu L. Quantitative Analysis of Myocardial Work by Non-invasive Left Ventricular Pressure-Strain Loop in Patients With Type 2 Diabetes Mellitus. Front Cardiovasc Med 2021; 8:733339. [PMID: 34660736 PMCID: PMC8517392 DOI: 10.3389/fcvm.2021.733339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a common risk factor for cardiovascular diseases. The aims of this study were to evaluate the changes in the left ventricular myocardial work in T2DM patients using the left ventricular pressure-strain loop (PSL) technique, and to explore the risk factors for the left ventricular myocardial work impairment. Methods: Fifty patients with T2DM and 50 normal controls (NCs) were included in the study. In addition to conventional echocardiography and two-dimensional speckle tracking echocardiography, the left ventricular myocardial work parameters were measured using PSL technology. Results: The absolute value for global longitudinal strain (GLS), global work index (GWI) and, global constructive work (GCW) were significantly decreased in the T2DM group (P < 0.05), while the left ventricular ejection fraction (LVEF) was not significantly different between the T2DM and NC groups. Multivariable linear regression analysis showed that hemoglobin A1c (HbA1c) was independently related to GWI (β = −0.452, P < 0.05), while HbA1c and the diabetes duration were independently related to GCW (β = −0.393, P < 0.05 and β = −0.298, P < 0.05, respectively). Conclusions: Changes in the left ventricular myocardial systolic function in T2DM patients were identified using PSL technology. HbA1c was shown to be an independent risk factor affecting GWI, while HbA1c and diabetes duration were demonstrated to be independent risk factors affecting GCW.
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Affiliation(s)
- Danqing Huang
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Cunying Cui
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Zheng
- School of Computer and Control Engineering, Yantai University, Yantai, China
| | - Yanan Li
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanbin Hu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Wang
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruijie Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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Lustosa RP, Fortuni F, van der Bijl P, Mahdiui ME, Montero-Cabezas JM, Kostyukevich MV, Knuuti J, Marsan NA, Delgado V, Bax JJ. Changes in Global Left Ventricular Myocardial Work Indices and Stunning Detection 3 Months After ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2021; 157:15-21. [PMID: 34366114 DOI: 10.1016/j.amjcard.2021.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Global left ventricular (LV) myocardial work (MW) indices (GLVMWI) are derived from speckle tracking echocardiographic strain data in combination with non-invasive blood pressure measurements. Changes in global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) after ST-segment elevation myocardial infarction (STEMI) have not been explored. The aim of present study was to assess the evolution of GLVMWI in STEMI patients from baseline (index infarct) to 3 months' follow-up. Three-hundred and fifty patients (265 men; mean age 61 ± 10 years) with STEMI treated with primary percutaneous coronary intervention (PCI) and guideline-based medical therapy were retrospectively evaluated. Clinical variables, conventional echocardiographic measures and GLVMWI were recorded at baseline within 48 hours post-primary PCI and 3 months' follow-up. LV ejection fraction (from 54 ± 10% to 57 ± 10%, p < 0.001), GWI (from 1449 ± 451 mm Hg% to 1953 ± 492 mm Hg%, p < 0.001), GCW (from 1624 ± 519 mm Hg% to 2228 ± 563 mm Hg%, p < 0.001) and GWE (from 93% (interquartile range (IQR) 86%-95%) to 95% (IQR 91%-96%), p < 0.001) improved significantly at 3 months' follow-up with no significant difference in GWW (from 101 mm Hg% (IQR 63-155 mm Hg%) to 96 mm Hg% (IQR 64-155 mm Hg%); p = 0.535). On multivariable linear regression analysis, lower values of troponin T at baseline, increase in systolic blood pressure and improvement in LV global longitudinal strain were independently associated with higher GWI and GCW at 3 months' follow-up. In conclusion, the evolution of GWI, GCW and GWE in STEMI patients may reflect myocardial stunning, whereas the stability in GWW may reflect permanent myocardial damage and the development of non-viable scar tissue.
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Myocardial Work by Echocardiography: Principles and Applications in Clinical Practice. J Clin Med 2021; 10:jcm10194521. [PMID: 34640537 PMCID: PMC8509621 DOI: 10.3390/jcm10194521] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022] Open
Abstract
Left ventricular (LV) global longitudinal strain (GLS) has established itself in the last decade as a reliable, more objective method for the evaluation of LV systolic function, able to detect subtle abnormalities in LV contraction even in the presence of preserved ejection fraction (EF). However, recent studies have demonstrated that GLS, similar to LV EF, has important load dependency. Non-invasive myocardial work (MW) quantification has emerged in the last years as an alternative tool for myocardial function assessment. This new method, incorporating measurement of strain and LV pressure, has shown to overcome GLS and LV EF limitations and provide a loading-independent evaluation of myocardial performance. The presence of a commercially available echocardiographic software for the non-invasive MW calculation has allowed the application of this new method in different settings. This review sought to provide an overview on the current knowledge of non-invasive MW estimation, showing its potential applications and possible added value in clinical practice.
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Meimoun P, Abdani S, Stracchi V, Elmkies F, Boulanger J, Botoro T, Zemir H, Clerc J. Usefulness of Noninvasive Myocardial Work to Predict Left Ventricular Recovery and Acute Complications after Acute Anterior Myocardial Infarction Treated by Percutaneous Coronary Intervention. J Am Soc Echocardiogr 2021; 33:1180-1190. [PMID: 33010853 DOI: 10.1016/j.echo.2020.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Predicting left ventricular recovery (LVR) after acute ST-elevation myocardial infarction (STEMI) is challenging and of prognostic importance. Our objective was to evaluate the usefulness of noninvasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LVR and in-hospital complications after STEMI. METHODS Ninety-three patients with anterior STEMI (mean age, 59 ± 12 years) treated by percutaneous coronary intervention (PCI) were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 24-48 hours after PCI and a median of 92 days at follow-up. Myocardial work is derived from the strain-pressure relation, integrating in its calculation the noninvasive arterial pressure. Segmental LVR was defined as a normalization of wall motion abnormalities of the affected segments and global recovery as an absolute improvement of left ventricular ejection fraction (LVEF) > 5% in patients with baseline LVEF ≤ 50%. In-hospital complications were defined as a composite of death, reinfarction, heart failure, and LV apical thrombus. RESULTS Segmental MW was impaired in infarct segments, more severely in nonrecovering versus recovering segments (P < .01). Furthermore, global constructive MW was significantly correlated with follow-up LVEF (r = 0.58) and global longitudinal strain (r = -0.67; all P < .01). Constructive MW was the best index to predict segmental (P < .01 vs MW index, MW efficiency, and wasted work) and global recovery (P < .05 vs global longitudinal strain) with an independent association (odds ratio = 1.17, 95% CI, 1.13-1.20, and odds ratio = 1.43, 95% CI, 1.18-1.68, respectively; all P < .001). Moreover, global constructive MW was more severely impaired in patients with in-hospital complications (n = 16; P < .01). CONCLUSIONS In patients with anterior STEMI treated by PCI, constructive MW is an independent predictor of segmental and global LVR and is significantly impaired in patients with in-hospital complications.
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Affiliation(s)
- Patrick Meimoun
- Department of Cardiology, Compiègne Hospital, Compiègne, France.
| | - Souad Abdani
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | | | | | | | - Thierry Botoro
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Hamdane Zemir
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Jerome Clerc
- Department of Cardiology, Compiègne Hospital, Compiègne, France
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Lustosa RP, Fortuni F, van der Bijl P, Goedemans L, El Mahdiui M, Montero-Cabezas JM, Kostyukevich MV, Ajmone Marsan N, Bax JJ, Delgado V, Knuuti J. Left ventricular myocardial work in the culprit vessel territory and impact on left ventricular remodelling in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Eur Heart J Cardiovasc Imaging 2021; 22:339-347. [PMID: 32642755 DOI: 10.1093/ehjci/jeaa175] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/21/2020] [Accepted: 06/07/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Adverse left ventricular (LV) remodelling after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Global and regional LV myocardial work (LVMW) derived from speckle tracking echocardiographic strain data in combination with non-invasive blood pressure recordings could provide information for prediction of LV remodelling after STEMI. The aim of the study was to assess the predictive value of global and regional LVMW for LV remodelling before discharge in patients with STEMI. METHODS AND RESULTS Three-hundred and fifty STEMI patients treated with primary percutaneous coronary intervention (PCI) were included [265 men (76%), mean age: 61 ± 10 years]. Clinical variables, conventional echocardiographic parameters, global and regional measures of myocardial work index (MWI), and myocardial work efficiency were recorded before discharge. The primary endpoint was early LV remodelling defined as increase in LV end-diastolic volume (LVEDV) ≥20% at 3 months after STEMI. Eighty-seven patients (25%) showed early LV remodelling. The global and regional LVMW in the culprit territory were significantly lower in patients with early LV remodelling. Peak troponin I (OR 1.109, 95% CI 1.046-1.177; P = 0.001), LVEDV (OR 0.972, 95% CI 0.959-0.984; P < 0.001) and regional MWI in the culprit vessel territory (OR 0.602, 95% CI 0.383-0.945; P = 0.027) were independently associated with early LV remodelling. CONCLUSION In STEMI patients treated with primary PCI and optimal medical therapy, the regional cardiac work index in the culprit vessel territory before discharge is independently associated with early adverse LV remodelling.
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Affiliation(s)
- Rodolfo P Lustosa
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Federico Fortuni
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Laurien Goedemans
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jose M Montero-Cabezas
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Marina V Kostyukevich
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Juhani Knuuti
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Turku PET Centre, Turku University Hospital and University of Turku, Kiinamllynkatu 4-8, 20520, Turku, Finland
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Butcher SC, Fortuni F, Montero-Cabezas JM, Abou R, El Mahdiui M, van der Bijl P, van der Velde ET, Ajmone Marsan N, Bax JJ, Delgado V. Right ventricular myocardial work: proof-of-concept for non-invasive assessment of right ventricular function. Eur Heart J Cardiovasc Imaging 2021; 22:142-152. [PMID: 33184656 DOI: 10.1093/ehjci/jeaa261] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/04/2020] [Indexed: 01/22/2023] Open
Abstract
AIMS Right ventricular myocardial work (RVMW) is a novel method for non-invasive assessment of right ventricular (RV) function utilizing RV pressure-strain loops. This study aimed to explore the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with heart failure with reduced left ventricular ejection fraction (HFrEF), and to compare values of RVMW with those of a group of patients without cardiovascular disease. METHODS AND RESULTS Non-invasive analysis of RVMW was performed in 22 HFrEF patients [median age 63 (59-67) years] who underwent echocardiography and invasive RHC within 48 h. Conventional RV functional measurements, RV global constructive work (RVGCW), RV global work index (RVGWI), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were analysed and compared with invasively measured stroke volume and stroke volume index. Non-invasive analysis of RVMW was also performed in 22 patients without cardiovascular disease to allow for comparison between groups. None of the conventional echocardiographic parameters of RV systolic function were significantly correlated with stroke volume or stroke volume index. In contrast, one of the novel indices derived non-invasively by pressure-strain loops, RVGCW, demonstrated a moderate correlation with invasively measured stroke volume and stroke volume index (r = 0.63, P = 0.002 and r = 0.59, P = 0.004, respectively). RVGWI, RVGCW, and RVGWE were significantly lower in patients with HFrEF compared to a healthy cohort, while values of RVGWW were significantly higher. CONCLUSION RVGCW is a novel parameter that provides an integrative analysis of RV systolic function and correlates more closely with invasively measured stroke volume and stroke volume index than other standard echocardiographic parameters.
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Affiliation(s)
- Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands.,Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth WA 6000, Australia
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, via Forlanini, 27100 Pavia, Italy
| | - Jose M Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Rachid Abou
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Enno T van der Velde
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
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Sahiti F, Morbach C, Henneges C, Stefenelli U, Scholz N, Cejka V, Albert J, Heuschmann PU, Ertl G, Frantz S, Angermann CE, Störk S. Dynamics of Left Ventricular Myocardial Work in Patients Hospitalized for Acute Heart Failure. J Card Fail 2021; 27:1393-1403. [PMID: 34332057 DOI: 10.1016/j.cardfail.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND The left ventricular ejection fraction (LVEF) is the most commonly used measure describing pumping efficiency, but it is heavily dependent on loading conditions and therefore not well-suited to study pathophysiologic changes. The novel concept of echocardiography-derived myocardial work (MyW) overcomes this disadvantage as it is based on LV pressure-strain loops. We tracked the in-hospital changes of indices of MyW in patients admitted for acute heart failure (AHF) in relation to their recompensation status and explored the prognostic utility of MyW indices METHODS AND RESULTS: We studied 126 patients admitted for AHF (mean 73 ± 12 years, 37% female, 40% with a reduced LVEF [<40%]), providing pairs of echocardiograms obtained both on hospital admission and prior to discharge. The following MyW indices were derived: global constructive and wasted work (GCW, GWW), global work index (GWI), and global work efficiency. In patients with HF with reduced ejection fraction with decreasing N-terminal prohormone B-natriuretic peptide levels during hospitalization, the GCW and GWI improved significantly, whereas the GWW remained unchanged. In patients with HF with preserved ejection fraction, the GCW and GWI were unchanged; however, in patients with no decrease or eventual increase in N-terminal prohormone B-natriuretic peptide, we observed an increase in GWW. In all patients with AHF, higher values of GWW were associated with a higher risk of death or rehospitalization within 6 months after discharge (per 10-point increment hazard ratio 1.035, 95% confidence interval 1.005-1.065). CONCLUSIONS Our results suggest differential myocardial responses to decompensation and recompensation, depending on the HF phenotype in patients presenting with AHF. The GWW predicted the 6-month prognosis in these patients, regardless of LVEF. Future studies in larger cohorts need to confirm our results and identify determinants of short-term and longer term changes in MyW.
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Affiliation(s)
- Floran Sahiti
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Carsten Henneges
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany
| | - Ulrich Stefenelli
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany
| | - Nina Scholz
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany
| | - Vladimir Cejka
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany
| | - Judith Albert
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Christiane E Angermann
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany.
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Myocardial Work, an Echocardiographic Measure of Post Myocardial Infarct Scar on Contrast-Enhanced Cardiac Magnetic Resonance. Am J Cardiol 2021; 151:1-9. [PMID: 34034906 DOI: 10.1016/j.amjcard.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022]
Abstract
This study investigates the relation of non-invasive myocardial work and myocardial viability following ST-segment elevation myocardial infarction (STEMI) assessed on late gadolinium contrast enhanced cardiac magnetic resonance (LGE CMR) and characterizes the remote zone using non-invasive myocardial work parameters. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were included. Several non-invasive myocardial work parameters were derived from speckle tracking strain echocardiography and sphygmomanometric blood pressure, e.g.: myocardial work index (MWI), constructive work (CW), wasted work (WW) and myocardial work efficiency (MWE). LGE was quantified to determine infarct transmurality and scar burden. The core zone was defined as the segment with the largest extent of transmural LGE and the remote zone as the diametrically opposed segment without LGE. A total of 53 patients (89% male, mean age 58 ± 9 years) and 689 segments were analyzed. The mean scar burden was 14 ± 7% of the total LV mass, and 76 segments (11%) demonstrated transmural hyperenhancement, 280 (41%) non-transmural hyperenhancement and 333 (48%) no LGE. An inverse relation was observed between segmental MWI, CW and MWE and infarct transmurality (p < 0.05). MWI, CW and MWE were significantly lower in the core zone compared to the remote zone (p<0.05). In conclusion, non-invasive myocardial work parameters may serve as potential markers of segmental myocardial viability in post-STEMI patients who underwent primary PCI. Non-invasive myocardial work can also be utilized to characterize the remote zone, which is an emerging prognostic marker as well as a therapeutic target.
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Riolet C, Menet A, Mailliet A, Binda C, Altes A, Appert L, Castel AL, Delelis F, Viart G, Guyomar Y, Le Goffic C, Decroocq M, Ennezat PV, Graux P, Tribouilloy C, Marechaux S. Clinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2021; 34:976-986. [PMID: 34157400 DOI: 10.1016/j.echo.2021.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The relationship between myocardial work assessment using pressure-strain loops by echocardiography before cardiac resynchronization therapy (CRT) and response to CRT has been recently revealed. Among myocardial work parameters, the impact of left ventricular myocardial global wasted work (GWW) on response to CRT and outcome following CRT has been seldom studied. Hence, the authors evaluated the relationship between preprocedural GWW and outcome in a large prospective cohort of patients with heart failure (HF) and reduced ejection fraction receiving CRT. METHODS The study included 249 patients with HF. Myocardial work indices including GWW were calculated using speckle-tracking strain two-dimensional echocardiography using pressure-strain loops. End points of the study were (1) response to CRT, defined as left ventricular reverse remodeling and/or absence of hospitalization for HF, and (2) all-cause death during follow-up. RESULTS Median follow-up duration was 48 months (interquartile range, 43-54 months). Median preoperative GWW was 281 mm Hg% (interquartile range, 184-388 mm Hg%). Preoperative GWW was associated with CRT response (area under the curve, 0.74; P < .0001), and a 200 mm Hg% threshold discriminated CRT nonresponders from responders with 85% specificity and 50% sensitivity, even after adjustment for known predictors of CRT response (adjusted odds ratio, 4.03; 95% CI, 1.91-8.68; P < .001). After adjustment for established predictors of outcome in patients with HF with reduced ejection fraction receiving CRT, GWW < 200 mm Hg% remained associated with a relative increased risk for all-cause death compared with GWW ≥ 200 mm Hg% (adjusted hazard ratio, 2.0; 95% CI, 1.1-3.9; P = .0245). Adding GWW to a baseline model including known predictors of outcome in CRT resulted in an improvement of this model (χ2 to improve 4.85, P = .028). The relationship between GWW and CRT response and outcome was stronger in terms of size effect and statistical significance than for other myocardial work indices. CONCLUSIONS Low preoperative GWW (<200 mm Hg%) is associated with absence of CRT response in CRT candidates and with a relative increased risk for all-cause death. GWW appears to be a promising parameter to improve selection for CRT of patients with HF with reduced ejection fraction.
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Affiliation(s)
- Clemence Riolet
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Aymeric Menet
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Amandine Mailliet
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Camille Binda
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Alexandre Altes
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Ludovic Appert
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Anne Laure Castel
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - François Delelis
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Guillaume Viart
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Yves Guyomar
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Caroline Le Goffic
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Marie Decroocq
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | | | - Pierre Graux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Christophe Tribouilloy
- EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France; Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Sylvestre Marechaux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France; EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France.
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Hedwig F, Nemchyna O, Stein J, Knosalla C, Merke N, Knebel F, Hagendorff A, Schoenrath F, Falk V, Knierim J. Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure. Front Cardiovasc Med 2021; 8:691611. [PMID: 34222382 PMCID: PMC8249920 DOI: 10.3389/fcvm.2021.691611] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/27/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: The aim of this study was to investigate whether echocardiographic assessment of myocardial work is a predictor of outcome in advanced heart failure. Background: Global work index (GWI) and global constructive work (GCW) are calculated by means of speckle tracking, blood pressure measurement, and a normalized reference curve. Their prognostic value in advanced heart failure is unknown. Methods: Cardiopulmonary exercise testing and echocardiography with assessment of GWI and GCW was performed in patients with advanced heart failure caused by ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular assist device, or heart transplantation. Results: The median patient age was 54 years (interquartile range [IQR]: 48–59.9). The mean left ventricular ejection fraction was 27.8 ± 8.2%, the median NT-proBNP was 1,210 pg/ml (IQR: 435–3,696). The mean GWI was 603 ± 329 mmHg% and the mean GCW was 742 ± 363 mmHg%. The correlation between peak oxygen uptake and GWI as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p = 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months (IQR: 12–18.5). Thirty one patients met the combined endpoint: Four patients died, eight underwent transplantation, and 19 underwent implantation of a left ventricular assist device. In the multivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI (hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77–0.94; p = 0.002) as well as GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79–0.94; p = 0.001) were identified as independent predictors of the endpoint. The cut-off value for predicting the outcome was 455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and 530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%). Conclusions: GWI and GCW are powerful predictors of outcome in patients with advanced heart failure.
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Affiliation(s)
- Felix Hedwig
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Olena Nemchyna
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | | | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Nicolas Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Hagendorff
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Leipzig, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Eidgenössische Technische Hochschule Zürich, Department of Health Sciences and Technology, Translational Cardiovascular Technology, Zurich, Switzerland
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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Minhas AS, Gilotra NA, Goerlich E, Metkus T, Garibaldi BT, Sharma G, Bavaro N, Phillip S, Michos ED, Hays AG. Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality. Front Cardiovasc Med 2021; 8:667721. [PMID: 34195234 PMCID: PMC8236710 DOI: 10.3389/fcvm.2021.667721] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Although troponin elevation is common in COVID-19, the extent of myocardial dysfunction and its contributors to dysfunction are less well-characterized. We aimed to determine the prevalence of subclinical myocardial dysfunction and its association with mortality using speckle tracking echocardiography (STE), specifically global longitudinal strain (GLS) and myocardial work efficiency (MWE). We also tested the hypothesis that reduced myocardial function was associated with increased systemic inflammation in COVID-19. Methods and Results: We conducted a retrospective study of hospitalized COVID-19 patients undergoing echocardiography (n = 136), of whom 83 and 75 had GLS (abnormal >-16%) and MWE (abnormal <95%) assessed, respectively. We performed adjusted logistic regression to examine associations of GLS and MWE with in-hospital mortality. Patients were mean 62 ± 14 years old (58% men). While 81% had normal left ventricular ejection fraction (LVEF), prevalence of myocardial dysfunction was high by STE; [39/83 (47%) had abnormal GLS; 59/75 (79%) had abnormal MWE]. Higher MWE was associated with lower in-hospital mortality in unadjusted [OR 0.92 (95% CI 0.85-0.99); p = 0.048] and adjusted models [aOR 0.87 (95% CI 0.78-0.97); p = 0.009]. In addition, increased systemic inflammation measured by interleukin-6 level was associated with reduced MWE. Conclusions: Subclinical myocardial dysfunction is common in COVID-19 patients with clinical echocardiograms, even in those with normal LVEF. Reduced MWE is associated with higher interleukin-6 levels and increased in-hospital mortality. Non-invasive STE represents a readily available method to rapidly evaluate myocardial dysfunction in COVID-19 patients and can play an important role in risk stratification.
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Affiliation(s)
- Anum S Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erin Goerlich
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Thomas Metkus
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brian T Garibaldi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicole Bavaro
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Susan Phillip
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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The non-invasive assessment of myocardial work by pressure-strain analysis: clinical applications. Heart Fail Rev 2021; 27:1261-1279. [PMID: 34041679 PMCID: PMC9197903 DOI: 10.1007/s10741-021-10119-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/10/2022]
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.
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45
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Huang J, Yang C, Yan ZN, Fan L, Ni CF. Global myocardial work: A new way to detect subclinical myocardial dysfunction with normal left ventricle ejection fraction in essential hypertension patients: Compared with myocardial layer-specific strain analysis. Echocardiography 2021; 38:850-860. [PMID: 34008233 DOI: 10.1111/echo.15063] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/10/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine whether global myocardial work (MW), derived from non-invasive left ventricle (LV) pressure-strain loops (PSL) at rest, could predict subclinical LV myocardial dysfunction in preserved left ventricular ejection fraction (LVEF) essential hypertension (EHT) patients. METHODS A total of 105 untreated EHT patients and 55 normal controls were enrolled in this study. Apical 4-, 3- and 2-chamber views were acquired by two-dimensional echocardiography. The peak systolic myocardial layer-specific longitudinal strain (epimyocardial: GLSEpi; middle layer: GLSMid; and endomyocardial: GLSEndo), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and myocardial work efficiency (GWE) were generated by speckle-tracking echocardiography (STE). RESULTS The values of GLSEpi, GLSMid, and GLSEndo were significantly lower in EHT patients with LVH than in EHT patients without LVH and normal controls. GWW was significantly increased in EHT patients with LVH compared with without LVH and normal subjects, while GWE was significantly reduced in EHT patients with LVH compared with without LVH and normal subjects. ROC analysis showed that combined global MW values were a more sensitive predictor for detecting the accuracy of LV subclinical dysfunction in EHT patients than layer-specific GLS. CONCLUSION From the research, we conclude that global MW is more sensitive to layer-specific GLS in its ability to detect subclinical LV dysfunction even in EHT patients even without LVH.
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Affiliation(s)
- Jun Huang
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Chao Yang
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zi-Ning Yan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Li Fan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Cai-Fang Ni
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China
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Roemer S, Jaglan A, Santos D, Umland M, Jain R, Tajik AJ, Khandheria BK. The Utility of Myocardial Work in Clinical Practice. J Am Soc Echocardiogr 2021; 34:807-818. [PMID: 33895250 DOI: 10.1016/j.echo.2021.04.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
Myocardial work (MW) is a novel technique used in the advanced assessment of left ventricular function. In the past few years, this invasive measure has evolved to become a more attainable noninvasive technique. MW has benefits over left ventricular ejection fraction and global longitudinal strain by speckle-tracking echocardiography, as it includes the afterload-dependent limitation and dynamic myocardial contraction in relationship to various loading conditions. In this article, the authors provide a summary overview and discuss the additive value noninvasive MW provides to left ventricular systolic function assessment. The authors explore the evolution of invasive to noninvasive MW, examine how to acquire and measure, discuss normal reference values, examine its role in a multitude of cardiac conditions that have been investigated in current research, review a variety of clinical applications, and discuss potential limitations. The goal is to allow the reader to see the benefits of this rapidly emerging application and be able to incorporate it into everyday practice.
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Affiliation(s)
- Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Akshar Jaglan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - David Santos
- GE Healthcare/Vingmed Ultrasound, Horten, Norway
| | - Matthew Umland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
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47
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Tretter JT, Pradhan S, Truong VT, Mullikin A, Mazur W, Hill GD, Redington AN, Taylor MD. Non-invasive left ventricular myocardial work indices in healthy adolescents at rest. Int J Cardiovasc Imaging 2021; 37:2429-2438. [PMID: 33723732 DOI: 10.1007/s10554-021-02218-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Global myocardial work (GMW) provides a metric of left ventricular (LV) function and energy consumption. Its non-invasive assessment by echocardiography correlates with invasive measures and normal values have been reported in healthy adults. We aimed to establish normal values in a healthy adolescent population. Fifty-two healthy adolescents (mean age = 14.5 ± 2.0 years, range 11-19 years, 62% male) with normal echocardiograms were included. Brachial cuff blood pressure was obtained immediately following apical imaging in the supine position. Post-processing of echocardiograms for speckle tracking strain measurement and derivation of global myocardial work indices from LV pressure-strain loops was performed. The mean global work index (GWI) was 1802.0 ± 264.4 mmHg% with mean global work efficiency of 95.5 ± 1.1%. The mean global constructive work (GCW) was 2054.5 ± 297.3 mmHg%, and the mean global wasted work 83.8 ± 28.1 mmHg%. On multivariable analysis, there were significant associations between both GWI and GCW with systolic blood pressure (β coefficient = 0.57, p < 0.001; β coefficient = 0.67, p < 0.001 respectively) and LV global longitudinal strain (GLS) (β coefficient = - 0.56, p < 0.001; β coefficient = - 0.52, p < 0.001 respectively). There were no associations with any of the work indices with age, sex, body surface area, heart rate or LV ejection fraction. This study provides echocardiographic reference ranges for non-invasive indices of GMW in normal adolescents.
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Affiliation(s)
- Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Sarah Pradhan
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Vien T Truong
- The Heart and Vascular Center, The Lindner Research Center, The Christ Hospital, Cincinnati, OH, USA
| | - Anna Mullikin
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Wojciech Mazur
- The Heart and Vascular Center, The Lindner Research Center, The Christ Hospital, Cincinnati, OH, USA
| | - Garick D Hill
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew N Redington
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael D Taylor
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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48
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Lustosa RP, Butcher SC, van der Bijl P, El Mahdiui M, Montero-Cabezas JM, Kostyukevich MV, Rocha De Lorenzo A, Knuuti J, Ajmone Marsan N, Bax JJ, Delgado V. Global Left Ventricular Myocardial Work Efficiency and Long-Term Prognosis in Patients After ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2021; 14:e012072. [PMID: 33653082 DOI: 10.1161/circimaging.120.012072] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction in patients with ST-segment-elevation myocardial infarction. However, LV global longitudinal strain does not take into consideration the effect of afterload. Novel speckle-tracking echocardiographic indices of myocardial work integrate blood pressure measurements (afterload) with LV global longitudinal strain. The present study aimed to investigate the prognostic value of global LV myocardial work efficiency (GLVMWE; reflecting LV performance) obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction. METHODS A total of 507 ST-segment-elevation myocardial infarction patients (mean age, 61±11 years; 76% men) were retrospectively analyzed. LV ejection fraction and GLVMWE were measured by transthoracic echocardiography within 48 hours of admission. GLVMWE was defined as the ratio of constructive work divided by the sum of constructive and wasted work in all LV segments and expressed as a percentage. Spline curve analysis was used to define the association between reduced GLVMWE and all-cause death. RESULTS After a median follow-up of 80 months (interquartile range, 67-97 months), 40 (8%) patients died. Patients with reduced GLVMWE (<86%) showed higher cumulative rates of all-cause mortality (17.5% versus 4.7%; log-rank P<0.001) in comparison with patients with preserved GLVMWE (≥86%). Reduced GLVMWE (<86%) showed an independent association with all-cause mortality (hazard ratio, 3.167 [95% CI, 1.679-5.972]; P<0.001). CONCLUSIONS Reduced GLVMWE (<86%) measured by transthoracic echocardiography within 48 hours of admission in ST-segment-elevation myocardial infarction patients is associated with worse long-term survival.
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Affiliation(s)
- Rodolfo P Lustosa
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.).,National Institute of Cardiology, Rio de Janeiro, Brazil (R.P.L., A.R.D.L.)
| | - Steele C Butcher
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.).,Department of Cardiology, Royal Perth Hospital, Western Australia, Australia (S.C.B.)
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.)
| | - Mohammed El Mahdiui
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.)
| | - Jose M Montero-Cabezas
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.)
| | - Marina V Kostyukevich
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.)
| | | | - Juhani Knuuti
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.).,Heart Center, Turku University Hospital and University of Turku, Turku, Finland (J.K., J.J.B.)
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.)
| | - Jeroen J Bax
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland (J.K., J.J.B.)
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.)
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Impact of cardiovascular risk factors on myocardial work-insights from the STAAB cohort study. J Hum Hypertens 2021; 36:235-245. [PMID: 33654241 PMCID: PMC8930764 DOI: 10.1038/s41371-021-00509-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 11/12/2022]
Abstract
Myocardial work is a new echocardiography-based diagnostic tool, which allows to quantify left ventricular performance based on pressure–strain loops, and has been validated against invasively derived pressure–volume measurements. Myocardial work is described by its components (global constructive work [GCW], global wasted work [GWW]) and indices (global work index [GWI], global work efficiency [GWE]). Applying this innovative concept, we characterized the prevalence and severity of subclinical left ventricular compromise in the general population and estimated its association with cardiovascular (CV) risk factors. Within the Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study we comprehensively phenotyped a representative sample of the population of Würzburg, Germany, aged 30–79 years. Indices of myocardial work were determined in 1929 individuals (49.3% female, mean age 54 ± 12 years). In multivariable analysis, hypertension was associated with a mild increase in GCW, but a profound increase in GWW, resulting in higher GWI and lower GWE. All other CV risk factors were associated with lower GCW and GWI, but not with GWW. The association of hypertension and obesity with GWI was stronger in women. We conclude that traditional CV risk factors impact selectively and gender-specifically on left ventricular myocardial performance, independent of systolic blood pressure. Quantifying active systolic and diastolic compromise by derivation of myocardial work advances our understanding of pathophysiological processes in health and cardiac disease.
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50
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Jain R, Khandheria BK, Tajik AJ. Myocardial Work in Aortic Stenosis: It Does Work! J Am Soc Echocardiogr 2021; 34:267-269. [DOI: 10.1016/j.echo.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
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