Non-invasive myocardial work is reduced during transient acute coronary occlusion

Sabatino, Jolanda; Rosa, Salvatore De; Leo, Isabella; Spaccarotella, Carmen; Mongiardo, Annalisa; Polimeni, Alberto; Sorrentino, Sabato; Salvo, Giovanni Di; Indolfi, Ciro

doi:10.1371/journal.pone.0244397

Cited by 15 publications

(10 citation statements)

References 44 publications

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“…33 Dyssynchronous contractions and postsystolic shortening, both conditions encountered in myocardial ischemia, may contribute to less efficient ejection and increased wasted work. 34 Although Chan et al 35 found that patients with nonischemic cardiomyopathy had higher GWW values than those with ischemic cardiomyopathy, we did not find in the present study a significant interaction among Figure 4 Kaplan-Meier estimates of survival free from death (A), according to GWW < 200 mm Hg% and $ 200 mm Hg% and adjusted survival free from death (B), according to GWW < 200 mm Hg% and $ 200 mm Hg%.…”

Section: Noninvasive Measurement Of Myocardial and Wasted Workcontrasting

confidence: 80%

Clinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy

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Menet

Mailliet

et al. 2021

Journal of the American Society of Echocardiography

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Background:The relationship between myocardial work assessment using pressure-strain loops by echocardiography before cardiac resynchronization therapy (CRT) and response to CRT has been recently revealed. Among myocardial work parameters, the impact of left ventricular myocardial global wasted work (GWW) on response to CRT and outcome following CRT has been seldom studied. Hence, the authors evaluated the relationship between preprocedural GWW and outcome in a large prospective cohort of patients with heart failure (HF) and reduced ejection fraction receiving CRT. Methods:The study included 249 patients with HF. Myocardial work indices including GWW were calculated using speckle-tracking strain two-dimensional echocardiography using pressure-strain loops. End points of the study were (1) response to CRT, defined as left ventricular reverse remodeling and/or absence of hospitalization for HF, and (2) all-cause death during follow-up.Results: Median follow-up duration was 48 months (interquartile range, 43-54 months). Median preoperative GWW was 281 mm Hg% (interquartile range, 184-388 mm Hg%). Preoperative GWW was associated with CRT response (area under the curve, 0.74; P < .0001), and a 200 mm Hg% threshold discriminated CRT nonresponders from responders with 85% specificity and 50% sensitivity, even after adjustment for known predictors of CRT response (adjusted odds ratio, 4.03; 95% CI, 1.91-8.68; P < .001). After adjustment for established predictors of outcome in patients with HF with reduced ejection fraction receiving CRT, GWW < 200 mm Hg% remained associated with a relative increased risk for all-cause death compared with GWW $ 200 mm Hg% (adjusted hazard ratio, 2.0; 95% CI, 1.1-3.9; P = .0245). Adding GWW to a baseline model including known predictors of outcome in CRT resulted in an improvement of this model (c 2 to improve 4.85, P = .028). The relationship between GWW and CRT response and outcome was stronger in terms of size effect and statistical significance than for other myocardial work indices.Conclusions: Low preoperative GWW (<200 mm Hg%) is associated with absence of CRT response in CRT candidates and with a relative increased risk for all-cause death. GWW appears to be a promising parameter to improve selection for CRT of patients with HF with reduced ejection fraction.

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Section: Noninvasive Measurement Of Myocardial and Wasted Workcontrasting

confidence: 80%

Clinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy

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Menet

Mailliet

et al. 2021

Journal of the American Society of Echocardiography

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“…The left ventricular (LV) Myocardial work (MW) is estimated as the area of the LV pressure-strain loop by a dedicated software (GE-Healthcare), as previously described [9]. However, the standardized pressure curve obtained experimentally to calculate MW by Russell et al was not validated in patients with aortic stenosis, in which higher pressure gradients are observed between the LV and the aorta.…”

Section: Calculation Of Non-invasive Myocardial Workmentioning

confidence: 99%

Non-Invasive Myocardial Work in Patients with Severe Aortic Stenosis

Rosa

Sabatino

Strangio

et al. 2022

JCM

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Changes in cardiac mechanics after correction of severe Aortic Stenosis (AS) are under-investigated. Myocardial Work (MW) is emerging as a useful non-invasive correlate of invasively measured myocardial performance and oxygen consumption. The aim of this study was to assess the usefulness of MW in the clinical management of patients with AS undergoing transcatheter aortic valve implantation (TAVI). Consecutive patients referred for TAVI were included in this observational study. Echocardiograms were performed before and after TAVI to measure Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), and Global Work Efficiency (GWE). Mean transvalvular gradient was significantly improved (p < 0.05), without significant changes in left ventricular ejection fraction, nor in global longitudinal strain (GLS). GWI (p < 0.001) and GCW (p < 0.001), but not GWW (p = 0.241) nor GWE (p = 0.854) were significantly reduced after TAVI. Patients with a low flow low gradient (LF-LG) AS had lower left ventricular ejection fraction (LVEF) (p < 0.001), worse global longitudinal strain (GLS) (p < 0.001), and lower baseline GWI (p < 0.001), GCW (p < 0.001) and GWE (p = 0.003). The improvement in GWI and GCW observed after TAVI in the general study population were abolished among LF-LG patients. In conclusion, non-invasive MW might be useful to further classify patients with AS and to predict non responders.

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“…However, their study was conducted on patients with acute myocardial infarction (AMI), and could not assess the ability of regional MWI to recognize CAST in patients with stable CAD. Another study demonstrated in a non-acute setting that non-invasive MW parameters were sensitive marker of myocardial ischemia during induced transient ACO ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

Prediction of Significant Coronary Artery Disease Through Advanced Echocardiography: Role of Non-invasive Myocardial Work

Sabatino

Rosa

Leo

et al. 2021

Front. Cardiovasc. Med.

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Background: Non-invasive prediction of critical coronary artery stenosis (CAST) in patients with coronary artery disease (CAD) is challenging. Strain parameters can often capture an impairment of regional longitudinal function; however, they are load dependent. A novel non-invasive method to estimate Myocardial Work (MW) has been recently proposed, showing a strong correlation with invasive work measurements. Our aim was to investigate the ability of non-invasive MW to predict the ischaemic risk area underlying a CAST.Methods and Results: The study population comprises 80 individuals: 50 patients with CAST and 30 controls (CTRL). Echocardiography recordings were obtained before coronary angiography to measure global longitudinal strain (GLS), Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial Work Efficiency (MWE). Global MWI (p = 0.048), MWE (p < 0.001), and MCW (p = 0.048) at baseline were significantly reduced in patients with CAST compared to controls (p < 0.05). Regional MWE within the myocardial segments underlying the CAST, but not LS, was significantly reduced compared to non-target segments (p < 0.001). At ROC analysis, the diagnostic performance to predict CAST for regional MWE (AUC = 0.920, p < 0.001) was higher compared to both regional post-systolic shortening index (PSI) (AUC = 0.600, p = 0.129) and regional LS (AUC = 0.546, p = 0.469).Conclusions: Non-invasive estimation of MW work indices is able to predict a CAST before invasive angiography.

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Non-invasive myocardial work is reduced during transient acute coronary occlusion

Cited by 15 publications

References 44 publications

Clinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy

Clinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy

Non-Invasive Myocardial Work in Patients with Severe Aortic Stenosis

Prediction of Significant Coronary Artery Disease Through Advanced Echocardiography: Role of Non-invasive Myocardial Work

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