Is myocardial work the piece of puzzle that we missed?

Abstract

This issue of the Journal brings an interesting study about the usefulness of novel echocardiographic set of parameters in a specific population that has been under investigation for a long time -pediatric patients after kidney transplantation. 1 The authors provided a short-term follow-up data regarding left ventricular (LV) structure, function, and myocardial work (MW) in a small population of children with kidney transplantation and found that LV MW was superior to LV global longitudinal strain (GLS) in evaluating of LV systolic function recovery in these specific patients. 1 Reported findings are of a clinical and research importance and therefore deserve further discussion and clarification.LV ejection fraction (LVEF) has been used as a gold standard parameter for assessment of LV systolic function. However, the large number of studies conducted over the last decade showed that GLS is more reproducible and sensitive on subtle changes in LV systolic function than LVEF and a significant, if not even better, predictor of adverse events in the large number of cardiovascular conditions. 2,3 Nevertheless, GLS is not a perfect parameter, and it has its limitations. One of the most commonly cited limitation of GLS is load-dependence, which is certainly lower than for tissue-Doppler derived parameters and LVEF, but still not neglectable and particularly important in patients who incline to prompt changes in load condition such as patients with decompensated heart failure and those with end-stage renal disease who are on dialysis program. 4,5 MW is not entirely novel set of parameters, as it was described for the first time more than a decade ago. It was evaluated by the pressure-volume relationship that represents the myocardial oxygen consumption and LV performance. Pressure-volume loop was measured with invasive methods, which explains why wider clinical usage is not feasible. More recently, MW was presented as a novel set of parameters that includes global work index (GWI), global constructed work (GCW), global wasted work (GWW), and global work efficiencyThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.