Background: Left ventricular myocardial work (MW) derived from non-invasive pressure–strain loops has emerged as a load-adjusted index of contractile performance. Its value for risk stratification in advanced heart failure (HF) remains uncertain. Methods: We retrospectively studied 151 consecutive patients with advanced HF undergoing comprehensive evaluation at our tertiary centre between January 2016 and December 2022. MW parameters—left ventricular global work index (LVGWI), global constructive work (LVGCW), global wasted work (LVGWW) and global work efficiency (LVGWE)—were derived from speckle-tracking echocardiography integrated with brachial blood pressure. Cardiopulmonary exercise testing (CPET), right heart catheterisation (RHC) and biochemical markers were obtained. Patients were stratified according to an LVGWI threshold of 600 mmHg%, identified by receiver operating characteristic (ROC) analysis for predicting the combined end point of cardiovascular mortality or HF hospitalisation. Correlations between MW and traditional indices were assessed, and event-free survival was analysed by Kaplan–Meier curves. Results: LVGWI correlated modestly with pVO2 (r = 0.35, p = 0.01) and left ventricular ejection fraction (r = 0.42, p < 0.001) and inversely with NT-proBNP (r = −0.30, p = 0.03). LVGWI displayed the largest area under the curve (AUC 0.76 95% confidence interval 0.65–0.85) for predicting the combined end point compared with pVO2 (AUC 0.73) and LVEF (AUC 0.67). Dichotomisation by LVGWI ≤ 600 mmHg% identified a high-risk group (Group A) with worse NYHA class, lower systolic blood pressure and reduced exercise capacity. After a median follow-up of 24 months, Group A exhibited significantly lower event-free survival (log-rank p = 0.02). Multivariable analysis was not performed owing to the limited sample size; therefore, findings should be interpreted with caution. Conclusions: In patients with advanced HF, left ventricular myocardial work, particularly LVGWI, provides incremental prognostic information beyond conventional markers. An LVGWI cut-off of 600 mmHg% derived from ROC analysis identified patients at increased risk of cardiovascular events and may inform timely referral for mechanical circulatory support or transplantation. Larger prospective studies are warranted to confirm these observations and to establish standardised thresholds across vendors.
Martini et al. (Wed,) studied this question.