Non-invasive myocardial work analysis in normal, at-risk for heart failure and heart failure patients during stress testing—a systematic review: a joint session with the Romanian Society of Cardiology (part III)

For over a decade, non-invasive myocardial work (MW) analysis, employing pressure-strain loops derived from strain deformation echocardiography, has been extensively studied across various left heart conditions. Recently, interest in MW variation during physical exercise or pharmacological stress testing has emerged. However, existing studies often involve heterogeneous populations, leaving the clinical significance of MW indices variation poorly understood. This review aims to systematically evaluate the literature on non-invasive MW parameter techniques and their changes during stress testing. MW analysis provides critical insights into cardiac function, aiding in the detection of underlying disease, such as coronary artery disease and heart failure. While numerous studies in diverse clinical settings have focused on MW assessment at rest, stress MW indices may more effectively predict treatment response and prognosis. Nevertheless, the current literature remains limited. Future research should prioritize addressing these knowledge gaps to fully harness the potential of MW analysis in clinical practice.