Distribution of myocardial work in arterial hypertension: insights from non-invasive left ventricular pressure-strain relations

Abstract

Background: A index of non-invasive myocardial work (MWI) can account for pressure during the assessment of cardiac function, potentially separating the influence of loading conditions from the influence of the underlying tissue remodelling. The aim is to assess LV function accounted for loading and explore hypertensive MWI distribution by comparing healthy individuals to hypertensive patients without and with localized basal septal hypertrophy (BSH).Methods and results: An echocardiogram was performed in 170 hypertensive patients and 20 healthy individuals.BSH was defined by a basal-to-mid septal wall thickness ratio ≥ 1.4. LV speckle-tracking was performed, and the MWI calculated globally and regionally for the apical, mid and basal regions. An apex-to-base gradient, seen in regional strain values, was preserved in the distribution of myocardial work, with the apical region compensating for the impairment of the basal segments. This functional redistribution was further pronounced in patients with localized BSH. In these patients, segmental MWI analysis revealed underlying impairment of regional work unrelated to acute loading conditions.Conclusions: Non-invasive MWI analysis offers the possibility to compare LV function regardless of blood pressure at the time of observation. Changes in MWI distribution can be seen in hypertension unrelated to the load-dependency of strain. Accentuated functional changes affirm the role of BSH as an echocardiographic marker in hypertension.

Global and Regional Myocardial Work in Female Adolescents with Weight Disorders

“…This was an unexpected finding since differences in BP were observed between our AN patients, OB patients and controls, confirming results of previous studies [7,8]. MW is a new variable that takes into account both deformation and afterload through interpretation of strain in relation to dynamic non-invasive LV pressure [12,13] (estimated using the method of Russel et al by measurement of cuff pressures [11,13,27]). The absence of differences in GMW between our groups, therefore, results from an interplay between the estimation of intraventricular pressure and the GLS curves, as shown by LV-PSL [11,13,30].…”

“…Recently, the non-invasive estimation of global myocardial work (GMW) by the assessment of LV pressure-strain loops (LV-PSL) has overcome this limitation by taking into account the loading conditions [11]. GMW, which reflects myocardial performance [12,13], cardiac glucose metabolism [14] and oxygen consumption [12], potentially enhances myocardial function assessment.…”

Myocardial Work: Methodology and Clinical Applications

“…However, in patients with chronic pressure overload, when myocardial remodeling and hypertrophy appears, tissue fibrosis is more pronounced and correlates with the inability of the hypertrophied segments to increase their work during an acute pressure overload. MW indices will be lower in this subgroup of patients [21]. These results show that MW is more sensitive in detecting segmental tissue fibrosis even in the early stages and can add valuable information when measured alongside EF and GLS.…”

“…This was confirmed in a previously published study that included hypertensive patients. It was demonstrated that, in acute pressure overload, EF remains unaffected and GLS decreases while MW indices show an increase [21]. In these patients, work increases as every segment must provide more energy to pump against the raised afterload.…”

Myocardial Work by Echocardiography: Principles and Applications in Clinical Practice

“…These data have been further confirmed by Tadic et al, who have also shown in hypertensive patients an additional impact on GCW of type-2 diabetes mellitus [ 28 ]. An analysis on 170 hypertensive patients also revealed an apex-to-base gradient in the distribution of MW, which reflected an impairment of the basal segments, compensated by the apical region, more pronounced in those with basal septal hypertrophy [ 59 ]. Thus, in the context of hypertensive patients MW seems to be more sensitive.…”