Association Between Echocardiographic Non-invasive Myocardial Work Indices and Myocardial Fibrosis in Patients With Dilated Cardiomyopathy

Abstract

Objectives: To analyze the association between global myocardial work indices evaluated by non-invasive left ventricular (LV) pressure-strain loop (PSL) and LV myocardial fibrosis in patients with dilated cardiomyopathy (DCM).Methods: A total of 57 patients with DCM were included in this prospective study. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global longitudinal strain (GLS) were measured using LVPSL. LV volumes and LV ejection fraction (LVEF) were evaluated using cardiac magnetic resonance imaging (CMRI), LV myocardial fibrosis was estimated at CMRI by qualitative assessment of late gadolinium enhancement (LGE). According to the CMRI, the studied population was divided into two groups, namely: patients without LGE (LGE-) and patients with LGE (LGE+).Results: The LGE+ group presented with increased age, LV end systolic volume (LVESV) index and reduced GWI, GCW, GWE, GLS, CMRI-derived LVEF (LVEFCMRI), the differences between the two groups were statistically significant (P < 0.05). After correcting for age and LVESV index, LVEFCMRI, GLS, GWI, GCW, and GWE retained independent associations with LV myocardial fibrosis. According to receiver operating characteristics (ROC) analysis, LVEFCMRI, and GCW showed larger AUC and higher accuracy, sensitivity, and specificity than GLS, the accuracy of predicting LV myocardial fibrosis ranged from high to low as: LVEFCMRI, GCW, GWE, GWI, and GLS.Conclusions: LVEFCMRI, GWI, GCW, GWE, and GLS remained significant predictors of LV myocardial fibrosis. LVEFCMRI, and GCW appeared to better predict LV myocardial fibrosis compared with GLS.

Myocardial Work in Echocardiography

“…57 Dilated cardiomyopathy GWI, GCW, and GWE are better predictors of fibrosis on MRI than GLS. 62 GWI and GCW found to be predictors of all-cause mortality and need for LV assist device implantation/transplantation. 63 Cardio-oncology Myocardial work indices associated with a higher probability of concurrent CTRCD than GLS in small subset of patients with >21 mm Hg systolic blood pressure reduction and a GLS change (<3.3%).…”

Clinical research progress of myocardial work in assessment and prediction of coronary artery disease in noninvasive pressure‐strain loop technique

“…Clinical assessment of LV systolic function in CAD provides a more accurate new indicator. PSL has also played an important role not only in the field of cardiology, but also in dilated cardiomyopathy, 52,53 hypertrophic cardiomyopathy, 54,55 right ventricular cardiomyopathy, 56 hypertension, 52,57 and the evaluation of cardiac synchronization therapy. 13,58,59 Changes in LVMW with exercise can also be an effective means of quantifying myocardial contractile reserve.…”

Detection of myocardial fibrosis: Where we stand

“…Myocardial work is another novel parameter of transthoracic echocardiography, reflecting the stroke work through pressure-strain loop by incorporating deformation and afterload information of the left ventricle ( 70 ). Recent studies indicated that parameters of myocardial work were associated with CMR findings of fibrosis and global constructive work (GCW) showed a better ability to predict myocardial fibrosis compared with GLS ( 71 , 72 ).…”