Myocardial work impact in the evaluation of advanced heart failure

Introduction Advanced heart failure (AdvHF) is characterized by persistent symptoms and signs despite maximum tolerated therapy. We aimed, to assess the impact of myocardial work (MW), a new semiautomated technique derived from speckle tracking echocardiography (STE), in stratifying a group of patients with AdvHF according to their exercise capacity and in predicting clinical outcome. Materials and methods We studied 114 patients with AdvHF referred for work-up screening for heart transplantation or left ventricular assist device insertion. All patients had detailed echocardiographic examination with MW evaluation, cardiopulmonary exercise test (CPET), and right heart catheterization (RHC). Data were divided according to the LVGWI values into two groups: group A included patients with LVGWI <600 mmHg% and group B included patients with values 600 mmHg%. Results the study has shown statistically significant correlations between MW parameter and both CPET and RHC parameters. In particular, LVGWI and LVGCW have manifested statistically relevant correlations with parameters representing systemic perfusion (such as pVO2, %VO2, and AT %VO2), pulmonary pressures (sPAP, dPAP, and PCWP), and pressure-volume loop (VAC and EES). LVGWE only correlated with pVO2, %VO2, VAC, and EES, without any link with pulmonary pressures. Furthermore, LVGWI (p<0.001), LVGCW (p<0.001) and LVGWW (p=0.002) were related to 5-years cardiovascular mortality and all-cause mortality as well as hospitalization and survival was significantly superior in group B than group A (p<0.001). Finally, LVGWI had the highest accuracy in predicting 5-years CV mortality (AUC=0.856), CV hospitalization (AUC=0.956), all-cause mortality (AUC=0.856), and all-cause hospitalization (AUC=0.896) compared to the rest of the echocardiographic, CPET’s and RHC’s parameters. Conclusions In our study MW has shown higher accuracy than other echocardiographic measurements in predicting clinical events and mortality. However, more trials are necessary for revalidating such measurements accuracy and relevance before they become ready for routine clinical use.