Prognostic implications of global, left ventricular myocardial work efficiency before cardiac resynchronization therapy

Abstract

Aims Cardiac resynchronization therapy (CRT) restores mechanical efficiency to the failing left ventricular (LV) by resynchronization of contraction. Global, LV myocardial work efficiency (GLVMWE) can be quantified non-invasively with echocardiography. The prognostic implication of GLVMWE remains unexplored, and we therefore related GLVMWE before CRT to long-term prognosis. Methods and results Data were analysed from an ongoing registry of patients with Class I indications for CRT. GLVMWE was defined as the ratio of constructive work in all LV segments, divided by the sum of constructive and wasted work in all LV segments, as a percentage. It was derived from speckle tracking strain echocardiography and non-invasive blood pressure measurements, taken pre-CRT. Patients were dichotomized according to baseline, median GLVMWE [75%; interquartile range (IQR) 66–81%]. A total of 153 patients (66 ± 10 years, 72% male, 48% ischaemic heart disease) were analysed. After a median follow-up of 57 months (IQR 28–76 months), 31% of patients died. CRT recipients with less efficient baseline energetics (GLVMWE <75%) demonstrated lower event rates than patients with more efficient baseline energetics (GLVMWE ≥75%) (log-rank test, P = 0.029). On multivariable analysis, global LV wasted work ratio <75% pre-CRT was independently associated with a decreased risk of all-cause mortality (hazard ratio 0.48, 95% confidence interval 0.25–0.92; P = 0.027), suggesting that the potential for improvement in LV efficiency is important for CRT benefit. Conclusion GLVMWE can be derived non-invasively from speckle tracking strain echocardiography and non-invasive blood pressure recordings. A lower GLVMWE before CRT is independently associated with improved long-term outcome.

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

“…In addition, the same authors observed an independent relationship between GCW and occurrence of cardiac death during follow-up but found no independent relationship between GWW and occurrence of cardiac death. 15 Van der Bijl et al 17 found an independent relationship between global LV wasted work ratio and mortality during follow-up in 153 patients receiving CRT. We observed here a strong relationship between preprocedural GWW, CRT response and mortality.…”

“…[10][11][12][13] Although previous studies have reported the relationship between myocardial work indices including global wasted work (GWW) and CRT response, [14][15][16] the link between GWW and outcome has seldom been studied, and divergent results have been noted. 15,17 Therefore, we aimed in the present study to evaluate the relationship among myocardial work indices obtained by PSLs and particularly GWW, response to CRT, and long-term mortality during follow-up in a large cohort of patients receiving CRT in clinical practice.…”

Myocardial work in assessment of left ventricular systolic function

“…В исследовании P. van der Bijl и соавт. (2019) изначально менее эффективная работа ЛЖ (GWE <75 %) перед выполнением РТ независимо ассоциировалась со сниженным ОБЗОРЫ § риском смерти от всех причин (ОР 0,48 при 95 % ДИ от 0,25 до 0,92; p=0,027) [27]. Таким образом, было доказано, что РТ показывает лучший результат в долгосрочной перспективе, если значительно повышает эффективность работы миокарда.…”

New capabilities in assessing the left ventricular contractility by two-dimensional speckle tracking echocardiography

“…установили, что пациенты с артериальной гипертензией имели статистически значимо более низкий GWI ЛЖ по сравнению с контрольной группой при нормальных значениях ФВ и GLS [16]. В ряде исследований показатели миокардиальной работы являлись дополнительными важными критериями отбора и контроля при проведении СRT [38][39][40]. K. Russel и соавт.…”