Background and Aims: Concentric LV remodeling and hypertrophy are common structural abnormalities in patients with heart failure with preserved ejection fraction (HFpEF) and tend to be accompanied by impaired LV function. Assessment of global myocardial work (GMW) using strain-pressure loop may provide more comprehensive assessment of LV myocardial function, overcoming the limitations of the conventional parameters. We investigated the value of GMW in patients with HFpEF and assessed the relationship of GMW with concentric remodeling and hypertrophy. Methods: Consecutive patients with HFpEF (n=107) and sex-matched healthy controls (n=32) were prospectively enrolled. Clinical and conventional echocardiography variables were obtained. Further analyses of o ine data were performed to obtain GMW indices including global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work e ciency (GWE). Association of concentric remodeling and hypertrophy with GMW was analyzed by univariate and multivariate analysis.Results: HFpEF patients showed lower GWE (94% vs 96%, P<0.001) and higher GWW (136 mmHg% vs 87 mmHg%, P=0.003) than control group, while GWI (2111 mmHg% vs 2146 mmHg%, P=0.877) and GCW (2369 mmHg% vs 2469 mmHg%, P=0.733) were comparable in the two groups. HFpEF patients with relative wall thickness (RWT) >0.42 had reduced GWE (93% vs 94%, P=0.015) compared to HFpEF patients with RWT≤0.42, while GWI, GCW, and GWW were comparable between these two subgroups.Multivariate analysis showed an independent association of RWT with GWI, GCW, and GWE, respectively. Conclusion: Impaired global myocardial work was detected in patients with HFpEF. Impaired LV GMW may be associated with increased RWT.

Background and Aims: Concentric LV remodeling and hypertrophy are common structural abnormalities in patients with heart failure with preserved ejection fraction (HFpEF) and tend to be accompanied by impaired LV function. Assessment of global myocardial work (GMW) using strain-pressure loop may provide more comprehensive assessment of LV myocardial function, overcoming the limitations of the conventional parameters. We investigated the value of GMW in patients with HFpEF and assessed the relationship of GMW with concentric remodeling and hypertrophy.Methods: Consecutive patients with HFpEF (n=107) and sex-matched healthy controls (n=32) were prospectively enrolled. Clinical and conventional echocardiography variables were obtained. Further analyses of offline data were performed to obtain GMW indices including global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE). Association of concentric remodeling and hypertrophy with GMW was analyzed by univariate and multivariate analysis.Results: HFpEF patients showed lower GWE (94% vs 96%, P<0.001) and higher GWW (136 mmHg% vs 87 mmHg%, P=0.003) than control group, while GWI (2111 mmHg% vs 2146 mmHg%, P=0.877) and GCW (2369 mmHg% vs 2469 mmHg%, P=0.733) were comparable in the two groups. HFpEF patients with relative wall thickness (RWT) >0.42 had reduced GWE (93% vs 94%, P=0.015) compared to HFpEF patients with RWT≤0.42, while GWI, GCW, and GWW were comparable between these two subgroups. Multivariate analysis showed an independent association of RWT with GWI, GCW, and GWE, respectively.Conclusion: Impaired global myocardial work was detected in patients with HFpEF. Impaired LV GMW may be associated with increased RWT.

Background During early systole, ischemic myocardium with reduced active force experiences early systolic lengthening (ESL). This study aimed to explore the diagnostic potential of myocardial ESL in suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF). Methods Overall, 195 suspected NSTE-ACS patients with normal wall motion and LVEF, who underwent speckle tracking echocardiography (STE) before coronary angiography, were included in this study. Patients were stratified into the coronary artery disease (CAD) group when there was ≥ 50% stenosis in at least one major coronary artery. The CAD patients were further stratified into the significant (≥ 70% reduction of vessel diameter) stenosis group or the nonsignificant stenosis group. Myocardial strain parameters, including global longitudinal strain (GLS), duration of early systolic lengthening (DESL), early systolic index (ESI), and post-systolic index (PSI), were analyzed using STE and compared between groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic accuracy. Logistic regression analysis was conducted to establish the independent and incremental determinants for the presence of significant coronary stenosis. Results The DESL and ESI values were higher in patients with CAD than those without CAD. In addition, CAD patients with significant coronary stenosis had higher DESL and ESI than those without significant coronary stenosis. The ROC analysis revealed that ESI was superior to PSI for identifying patients with CAD, and further superior to GLS and PSI for predicting significant coronary stenosis. Moreover, ESI could independently and incrementally predict significant coronary stenosis in patients with CAD. Conclusions The myocardial ESI is of great value for the diagnosis and risk stratification of clinically suspected NSTE-ACS patients with normal LVEF and wall motion.