Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis

Galli, Elena; Vitel, Emilie; Schnell, Frédéric; Rolle, Virginie Le; Hubert, Arnaud; Léderlin, Mathieu; Donal, Erwan

doi:10.1111/echo.14210

Cited by 98 publications

(83 citation statements)

References 30 publications

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“…Normal values have recently been published and work indices have been measured in patients with heart failure . This work describes for the first time the relation between classic prognostic parameters and work indices in a heart failure population.…”

Section: Discussionmentioning

confidence: 99%

“…14 Normal values have recently been published and work indices have been measured in patients with heart failure. 7,9,15 This work describes for the first time the relation between classic prognostic parameters and work indices in a heart failure population. We retrospectively analyzed data from patients who presented in our outpatient heart failure unit between October 2018 and February 2019.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been studied additionally in acute coronary syndrome where it may serve as an important tool for selecting patients in need for prompt invasive treatment . Furthermore, myocardial work has been shown to be impaired in patients with hypertrophic cardiomyopathy and left ventricular fibrosis and in patients with dilated cardiomyopathy compared to control groups …”

Section: Introductionmentioning

confidence: 99%

“…8 Furthermore, myocardial work has been shown to be impaired in patients with hypertrophic cardiomyopathy and left ventricular fibrosis and in patients with dilated cardiomyopathy compared to control groups. 9,10 The aim of this study was to investigate the relationship between the new measures of noninvasive pressure-strain analysis and established prognostic parameters of echocardiography, CPX, and biomarkers.…”

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confidence: 99%

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Global work index correlates with established prognostic parameters of heart failure

et al. 2020

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Aim Identification of patients with heart failure and a poor prognosis is paramount to ensure timely and adequate treatment. We investigated the relationship between the new measures of noninvasive pressure‐strain analysis, such as the global work index (GWI), and established prognostic parameters of echocardiography, cardiopulmonary exercise test (CPX), and N‐terminal pro‐B‐type natriuretic peptide (NT‐pro‐BNP). Methods and Results We retrospectively analyzed data of 51 patients with heart failure. Echocardiography and CPX were performed, and NT‐pro‐BNP was determined. Patients with a GWI < 500 mm Hg% had a mean LVEDV of 286.1 ± 100.8 mL, an LVEF of 21.3 ± 5.7%, and a stroke volume (SV) of 45.9 ± 11.6 mL, and patients with a GWI > 1000 mm Hg% had an LVEDV of 147.9 ± 39.6 mL, an LVEF of 42.6 ± 4.8%, and a SV of 70.9 ± 14.3 mL. The GWI also showed a significant correlation with peak oxygen consumption (peak VO2) (r = .521; P < .001) and with NT‐pro‐BNP (r = .635; P < .001). Patients with a GWI of <500 mm Hg% had a significantly higher NT‐pro‐BNP (median 2415 pg/mL [IQR 1071, 5933]) and a lower peak VO2 (9.5 mL/min/kg ± 2.6) compared to patients with a GWI of >1000 mm Hg% (NT‐pro‐BNP median 253 pg/mL [IQR 150, 549]; peak VO2 15.6 ± 4.2 mL/min/kg). Conclusion GWI correlates with known prognostic markers of heart failure. A GWI of <500 mm Hg% was a predictor of severely impaired ejection fraction, very low exercise capacity, and strongly elevated NT‐pro‐BNP, indicating a poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Global work index correlates with established prognostic parameters of heart failure

et al. 2020

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“…Results show globally a good agreement between work index estimations from LV pressure obtained with patient-specific simulations and with experimental measurements. The evaluation of cardiac work, in the case of AS, is promising because it could be a simple and physiological alternative to more complex and costly investigations (cardiac MRI,‥) for the evaluation of myocardial contractility and residual myocardial viability [30]. The assessment of regional myocardial work might be particularly important for the prognosis of patients with severe asymptomatic AS without LV dysfunction.…”

Section: Plos Onementioning

confidence: 99%

Model-based estimation of left ventricular pressure and myocardial work in aortic stenosis

et al. 2020

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This paper proposes a model-based estimation of left ventricular (LV) pressure for the evaluation of constructive and wasted myocardial work of patients with aortic stenosis (AS). A model of the cardiovascular system is proposed, including descriptions of i) cardiac electrical activity, ii) elastance-based cardiac cavities, iii) systemic and pulmonary circulations and iv) heart valves. After a sensitivity analysis of model parameters, an identification strategy was implemented using a Monte-Carlo cross-validation approach. Parameter identification procedure consists in two steps for the estimation of LV pressures: step 1) from invasive, intraventricular measurements and step 2) from non-invasive data. The proposed approach was validated on data obtained from 12 patients with AS. The total relative errors between estimated and measured pressures were on average 11.9% and 12.27% and mean R 2 were equal to 0.96 and 0.91, respectively for steps 1 and 2 of parameter identification strategy. Using LV pressures obtained from non-invasive measurements (step 2) and patient-specific simulations, Global Constructive (GCW), Wasted (GWW) myocardial Work and Global Work Efficiency (GWE) parameters were calculated. Correlations between measures and model-based estimations were 0.88, 0.80, 0.91 respectively for GCW, GWW and GWE. The main contributions concern the proposal of the parameter identification procedure, applied on an integrated cardiovascular model, able to reproduce LV pressure specifically to each AS patient, by non-invasive procedures, as well as a new method for the non-invasive estimation of constructive, wasted myocardial work and work efficiency in AS. OPEN ACCESS Citation: Owashi KP, Hubert A, Galli E, Donal E, Hernández AI, Le Rolle V (2020) Model-based estimation of left ventricular pressure and myocardial work in aortic stenosis. PLoS ONE 15 (3): e0229609. https://doi.org/10.only upon the contractility of LV, but also on loading conditions. In fact, ejection fraction may appear to be preserved despite underlying reduced contractility The characterisation of myocardial dysfunction is of primary importance to identify patients with reduced contractility. Speckle-tracking echocardiography (STE) assessment of myocardial strain usually provides a better quantification of systolic function than global LVEF [4]. Although strain echocardiography can provide prognostic information in patients with AS [5], the shortening indices, calculated from cardiac strains, do not reflect myocardial work or oxygen demand. As opposed to the normal LV, where all segments contract almost synchronously and myocardial energy is used effectively, regional dysfunction, that could be induced by myocardial fibrosis [6], could bring a significant loss of efficient work. For instance, the impairment of myocardial diastolic and systolic function, due to fibrosis [7], have shown to induce significant mechanical dispersion in patients with severe AS [8].Recently, Russell et al [9,10] have proposed a non-invasive method for LV work analysis, w...

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Myocardial work—A new tool for early detection of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone chemotherapy induced‐cardiotoxicity in hematological patients

Mihalcea

Memis

Balinisteanu

et al. 2022

J of Clinical Ultrasound

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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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Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis

Cited by 98 publications

References 30 publications

Global work index correlates with established prognostic parameters of heart failure

Global work index correlates with established prognostic parameters of heart failure

Model-based estimation of left ventricular pressure and myocardial work in aortic stenosis

Myocardial work—A new tool for early detection of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone chemotherapy induced‐cardiotoxicity in hematological patients

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