Key result
Patients with heart failure with preserved ejection fraction had significantly lower global work efficiency (94% vs 96%) than healthy controls, which was further reduced in those with increased relative wall thickness.
Why the study?
Assessment of global myocardial work using strain-pressure loops may overcome limitations of conventional parameters to evaluate LV function and its relationship with concentric remodeling and hypertrophy in HFpEF.
Does global myocardial work assessment using strain-pressure loop reveal impaired left ventricular function associated with concentric remodeling in patients with HFpEF?
Observational (n=139)
No
Does global myocardial work assessment using strain-pressure loop reveal impaired left ventricular function associated with concentric remodeling in patients with HFpEF?
Absolute Event Rate: 94% vs 96%
p-value: p=<0.001
Global myocardial work efficiency is impaired in HFpEF patients and independently associated with increased relative wall thickness, providing a sensitive marker for subclinical myocardial dysfunction.
May identify subclinical LV dysfunction in HFpEF; leaves open whether myocardial work indices improve risk stratification.
Background and Aims: Concentric LV remodeling and hypertrophy are common structural abnormalities in patients with heart failure with preserved ejection fraction (HFpEF) and tend to be accompanied by impaired LV function. Assessment of global myocardial work (GMW) using strain-pressure loop may provide more comprehensive assessment of LV myocardial function, overcoming the limitations of the conventional parameters. We investigated the value of GMW in patients with HFpEF and assessed the relationship of GMW with concentric remodeling and hypertrophy. Methods: Consecutive patients with HFpEF (n=107) and sex-matched healthy controls (n=32) were prospectively enrolled. Clinical and conventional echocardiography variables were obtained. Further analyses of offline data were performed to obtain GMW indices including global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE). Association of concentric remodeling and hypertrophy with GMW was analyzed by univariate and multivariate analysis. Results: HFpEF patients showed lower GWE (94% vs 96%, P <0.001) and higher GWW (136 mmHg% vs 87 mmHg%, P =0.003) than control group, while GWI (2111 mmHg% vs 2146 mmHg%, P =0.877) and GCW (2369 mmHg% vs 2469 mmHg%, P =0.733) were comparable in the two groups. HFpEF patients with relative wall thickness (RWT) >0.42 had reduced GWE (93% vs 94%, P =0.015) compared to HFpEF patients with RWT≤0.42, while GWI, GCW, and GWW were comparable between these two subgroups. Multivariate analysis showed an independent association of RWT with GWI, GCW, and GWE, respectively. Conclusion: Impaired global myocardial work was detected in patients with HFpEF. Impaired LV GMW may be associated with increased RWT.
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Lin et al. (2022) conducted an observational in Heart failure with preserved ejection fraction (n=139). Heart failure with preserved ejection fraction vs. Healthy controls was evaluated on Global work efficiency (GWE) (p=<0.001). Patients with heart failure with preserved ejection fraction had significantly lower global work efficiency (94% vs 96%) than healthy controls, which was further reduced in those with increased relative wall thickness.
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