Stress Echocardiographic Myocardial Work in Healthy Adults and Heart Failure with Preserved Ejection Fraction Patients and Doubt about Early Systolic Lengthening

Background The aims of this study were (1) to characterize myocardial work (MW) changes from rest to after exercise in healthy adults and heart failure patients with preserved ejection fraction (HFpEF), and (2) to explore the factors influencing the decrease in global work efficiency (GWE) after exercise in healthy adults. Methods This study enrolled 167 healthy adults and 38 HFpEF patients. All subjects underwent echocardiographic assessment at rest and immediately after a symptom-limited treadmill stress test. Results GWE decreased after exercise in healthy adults. It was higher in women after exercise (women: 93% vs. men: 91%, p < 0.05). GWE was significantly lower after exercise in HFpEF patients (HFpEF: 85% vs. healthy: 92%, p < 0.05). The peak positive strain (PPS) was independently associated with global wasted work (GWW) both in healthy adults and HFpEF patients (healthy adults: r = 0.77, p < 0.001 at rest; r = 0.72, p < 0.001 after exercise; HFpEF: r = 0.74, p < 0.001 at rest; and r = 0.62, p < 0.001 after exercise). Conclusions MW parameters were less affected by sex in healthy individuals. MW parameters were lower in HFpEF than healthy adults both at rest and after exercise. GWE decreased in healthy adults after exercise because of increased GWW, and PPS was independently associated with GWW both at rest and under load, suggesting that early systolic lengthening (ESL) may be beneficial for subsequent contraction of the myocardium.