Clinical implication of non-invasive myocardial work measurements in patients undergoing left ventricular assist device implantation

Aims Non-invasive myocardial work integrates myocardial deformation and afterload and may improve assessment of left ventricular (LV) function. We evaluated whether preoperative myocardial work indices predict postoperative outcomes in heart failure patients undergoing durable left ventricular assist device (LVAD) implantation. Methods In this retrospective cohort, transthoracic echocardiography (TTE) with simultaneous non-invasive blood pressure measurement was used to derive LV global work index (GWI). Clinical risk scores (HeartMate II risk score [HMRS], HeartMate 3 risk score [HM3RS], European System for Cardiac Operative Risk Evaluation II [EuroSCORE II], Michigan right-heart-failure score [MRHFS], and EUROMACS right-heart-failure score [EUROMACS-RHF]) were calculated. Univariable and multivariable predictors of postoperative right heart failure (RHF) and mortality were evaluated using ridge-penalized logistic regression with bootstrap validation and ROC analysis. Continuous predictors were standardized (per 1 standard deviation). Results Fifty-three patients were included. In penalized regression, MRHFS was the strongest independent predictor of postoperative RHF (OR per 1-SD 2.80; 95% CI 1.55–5.05; p = 0.001; apparent AUC ≈ 0.90). Lower preoperative LV-GWI independently predicted long-term mortality (adjusted OR per 1 mmHg 0.98; 95% CI 0.97–0.99; p = 0.002) and showed high apparent discrimination (apparent AUC ≈ 0.90); optimism-corrected AUC for a multivariable model including standardized GWI, age, EuroSCORE II, and MRHFS was 0.88. Conventional TTE indices were not predictive after adjustment. Conclusions In patients undergoing durable left ventricular assist device implantation, preoperative non-invasive global left-ventricular myocardial work index improved prediction of mortality beyond established scores. The Michigan right-heart-failure score accurately identified patients at risk of right-ventricular failure.