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Published in: Cardiovascular Ultrasound 1/2021

Open Access 01-12-2021 | Research

Afterload-related reference values for myocardial work indices

Authors: Qiancheng Li, Hui Wang, Haiyan Feng, Tingfan Wu, Ying Yang, Dongmei Gao, Lina Sun

Published in: Cardiovascular Ultrasound | Issue 1/2021

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Abstract

Background

The novel noninvasive pressure-strain loop (PSL) is a reliable tool that reflects myocardial work (MW). Systolic blood pressure (SBP) is the only independent factor for MW indices. However, afterload-related reference values have not been previously reported. The aim of the present study was to establish reference values for MW parameters by wide range SBP grading.

Methods

We prospectively selected healthy individuals and subjects with SBP ≥ 140 mmHg at the time of study without myocardial remodeling. MW parameters were collected and the reference values achieved were grouped by SBP in 10-mmHg.

Results

Significant differences were noted among the SBP-groups for global work index (GWI) and global constructive work (GCW). The majority of statistical comparisons of the differences in GWI and GCW were significant at each SBP-group. With SBP ranging from 90 to 189 mmHg, the parameters GWI and GCW tended to increase linearly with afterload. Overall, the global wasted work (GWW) tended to rise as SBP was increased, but not all of the differences noted in GWW were significant for each SBP-group. Global work efficiency (GWE) remained stable across all SBP-groups, with the exception of a slight drop noted when it exceeded 160 mmHg.

Conclusions

The amount of MW but not the work efficiency varied greatly according to the different afterload. This finding cannot be ignored during clinical research or diagnosis and afterload-related reference values are required to make a reasonable judgment on the myocardial function.
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Literature
1.
go back to reference Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Remme EW, et al. A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work. Eur Heart J. 2012;33:724–33.CrossRef Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Remme EW, et al. A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work. Eur Heart J. 2012;33:724–33.CrossRef
2.
go back to reference Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Gjesdal O, et al. Assessment of wasted myocardial work: a novel method to quantify energy loss due to uncoordinated left ventricular contractions. Am J Physiol Heart Circ Physiol. 2013;305:H996-1003.CrossRef Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Gjesdal O, et al. Assessment of wasted myocardial work: a novel method to quantify energy loss due to uncoordinated left ventricular contractions. Am J Physiol Heart Circ Physiol. 2013;305:H996-1003.CrossRef
3.
go back to reference Hubert A, Le Rolle V, Leclercq C, Galli E, Samset E, Casset C, et al. Estimation of myocardial work from pressure-strain loops analysis: an experimental evaluation. Eur Heart J Cardiovasc Imaging. 2018;19:1372–9.CrossRef Hubert A, Le Rolle V, Leclercq C, Galli E, Samset E, Casset C, et al. Estimation of myocardial work from pressure-strain loops analysis: an experimental evaluation. Eur Heart J Cardiovasc Imaging. 2018;19:1372–9.CrossRef
4.
go back to reference Boe E, Skulstad H, Smiseth OA. Myocardial work by echocardiography: a novel method ready for clinical testing. Eur Heart J Cardiovasc Imaging. 2019;20:18–20.CrossRef Boe E, Skulstad H, Smiseth OA. Myocardial work by echocardiography: a novel method ready for clinical testing. Eur Heart J Cardiovasc Imaging. 2019;20:18–20.CrossRef
5.
go back to reference Yingchoncharoen T, Agarwal S, Popović ZB, Marwick TH. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr. 2013;26:185–91.CrossRef Yingchoncharoen T, Agarwal S, Popović ZB, Marwick TH. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr. 2013;26:185–91.CrossRef
6.
go back to reference Boe E, Russell K, Eek C, Eriksen M, Remme EW, Smiseth OA, et al. Non-invasive myocardial work index identifies acute coronary occlusion in patients with non-ST-segment elevation-acute coronary syndrome. Eur Heart J Cardiovasc Imaging. 2015;16:1247–55.CrossRef Boe E, Russell K, Eek C, Eriksen M, Remme EW, Smiseth OA, et al. Non-invasive myocardial work index identifies acute coronary occlusion in patients with non-ST-segment elevation-acute coronary syndrome. Eur Heart J Cardiovasc Imaging. 2015;16:1247–55.CrossRef
7.
go back to reference Manganaro R, Marchetta S, Dulgheru R, Ilardi F, Sugimoto T, Robinet S, et al. Echocardiographic reference ranges for normal non-invasive myocardial work indices: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2019;20:582–90.CrossRef Manganaro R, Marchetta S, Dulgheru R, Ilardi F, Sugimoto T, Robinet S, et al. Echocardiographic reference ranges for normal non-invasive myocardial work indices: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2019;20:582–90.CrossRef
8.
go back to reference Galli E, John-Matthwes B, Rousseau C, Schnell F, Leclercq C, Donal E. Echocardiographic reference ranges for myocardial work in healthy subjects: A preliminary study. Echocardiography. 2019;36:1814–24.CrossRef Galli E, John-Matthwes B, Rousseau C, Schnell F, Leclercq C, Donal E. Echocardiographic reference ranges for myocardial work in healthy subjects: A preliminary study. Echocardiography. 2019;36:1814–24.CrossRef
9.
go back to reference Morbach C, Sahiti F, Tiffe T, Cejka V, Eichner FA, Gelbrich G, et al. Myocardial work - correlation patterns and reference values from the population-based STAAB cohort study. PLoS ONE. 2020;15:e0239684.CrossRef Morbach C, Sahiti F, Tiffe T, Cejka V, Eichner FA, Gelbrich G, et al. Myocardial work - correlation patterns and reference values from the population-based STAAB cohort study. PLoS ONE. 2020;15:e0239684.CrossRef
10.
go back to reference Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013;14:611–44.CrossRef Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013;14:611–44.CrossRef
11.
go back to reference Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–70.CrossRef Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–70.CrossRef
12.
go back to reference Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:1321–60.CrossRef Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:1321–60.CrossRef
14.
go back to reference Sagawa K, Suga H, Shoukas AA, Bakalar KM. End-systolic pressure/volume ratio: a new index of ventricular contractility. Am J Cardiol. 1977;40:748–53.CrossRef Sagawa K, Suga H, Shoukas AA, Bakalar KM. End-systolic pressure/volume ratio: a new index of ventricular contractility. Am J Cardiol. 1977;40:748–53.CrossRef
15.
go back to reference Suga H. Total mechanical energy of a ventricle model and cardiac oxygen consumption. Am J Physiol. 1979;236:H498-505.PubMed Suga H. Total mechanical energy of a ventricle model and cardiac oxygen consumption. Am J Physiol. 1979;236:H498-505.PubMed
16.
go back to reference Hisano R, Cooper G 4th. Correlation of force-length area with oxygen consumption in ferret papillary muscle. Circ Res. 1987;61:318–28.CrossRef Hisano R, Cooper G 4th. Correlation of force-length area with oxygen consumption in ferret papillary muscle. Circ Res. 1987;61:318–28.CrossRef
17.
go back to reference Forrester JS, Tyberg JV, Wyatt HL, Goldner S, Parmely WW, Swan HJ. Pressure-length loop: a new method for simultaneous measurement of segmental and total cardiac function. J Appl Physiol. 1974;37:771–5.CrossRef Forrester JS, Tyberg JV, Wyatt HL, Goldner S, Parmely WW, Swan HJ. Pressure-length loop: a new method for simultaneous measurement of segmental and total cardiac function. J Appl Physiol. 1974;37:771–5.CrossRef
18.
go back to reference Mele D, Trevisan F, Fiorencis A, Smarrazzo V, Bertini M, Ferrari R. Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis. Curr Heart Fail Rep. 2020;17:384–96.CrossRef Mele D, Trevisan F, Fiorencis A, Smarrazzo V, Bertini M, Ferrari R. Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis. Curr Heart Fail Rep. 2020;17:384–96.CrossRef
19.
go back to reference Kostyukevich MV, van der Bijl P, Vo NM, Lustosa RP, Pio SM, Bootsma M, et al. Regional Left Ventricular Myocardial Work Indices and Response to Cardiac Resynchronization Therapy. JACC Cardiovasc Imaging. 2020;13:1852–4.CrossRef Kostyukevich MV, van der Bijl P, Vo NM, Lustosa RP, Pio SM, Bootsma M, et al. Regional Left Ventricular Myocardial Work Indices and Response to Cardiac Resynchronization Therapy. JACC Cardiovasc Imaging. 2020;13:1852–4.CrossRef
20.
go back to reference Prinzen FW, Lumens J. Investigating myocardial work as a CRT response predictor is not a waste of work. Eur Heart J. 2020;41:3824–6.CrossRef Prinzen FW, Lumens J. Investigating myocardial work as a CRT response predictor is not a waste of work. Eur Heart J. 2020;41:3824–6.CrossRef
21.
go back to reference Galli E, Leclercq C, Fournet M, Hubert A, Bernard A, Smiseth OA, et al. Value of Myocardial Work Estimation in the Prediction of Response to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr. 2018;31:220–30.CrossRef Galli E, Leclercq C, Fournet M, Hubert A, Bernard A, Smiseth OA, et al. Value of Myocardial Work Estimation in the Prediction of Response to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr. 2018;31:220–30.CrossRef
22.
go back to reference Vecera J, Penicka M, Eriksen M, Russell K, Bartunek J, Vanderheyden M, et al. Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. 2016;17:624–32.CrossRef Vecera J, Penicka M, Eriksen M, Russell K, Bartunek J, Vanderheyden M, et al. Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. 2016;17:624–32.CrossRef
23.
go back to reference Galli E, Leclercq C, Hubert A, Bernard A, Smiseth OA, Mabo P, et al. Role of myocardial constructive work in the identification of responders to CRT. Eur Heart J Cardiovasc Imaging. 2018;19:1010–8.CrossRef Galli E, Leclercq C, Hubert A, Bernard A, Smiseth OA, Mabo P, et al. Role of myocardial constructive work in the identification of responders to CRT. Eur Heart J Cardiovasc Imaging. 2018;19:1010–8.CrossRef
24.
go back to reference Tomoaia R, Beyer RS, Zdrenghea D, Dadarlat-Pop A, Cismaru G, Gusetu G, et al. Global work index by non-invasive pressure-strain loops: a novel parameter to assess left ventricular performance in the early stages of heart failure with preserved or mid-range ejection fraction after acute myocardial infarction. Med Ultrason. 2020. https://doi.org/10.11152/mu-2672.CrossRefPubMed Tomoaia R, Beyer RS, Zdrenghea D, Dadarlat-Pop A, Cismaru G, Gusetu G, et al. Global work index by non-invasive pressure-strain loops: a novel parameter to assess left ventricular performance in the early stages of heart failure with preserved or mid-range ejection fraction after acute myocardial infarction. Med Ultrason. 2020. https://​doi.​org/​10.​11152/​mu-2672.CrossRefPubMed
25.
go back to reference Borrie A, Goggin C, Ershad S, Robinson W, Sasse A. Noninvasive Myocardial Work Index: Characterizing the Normal and Ischemic Response to Exercise. J Am Soc Echocardiogr. 2020;33:1191–200.CrossRef Borrie A, Goggin C, Ershad S, Robinson W, Sasse A. Noninvasive Myocardial Work Index: Characterizing the Normal and Ischemic Response to Exercise. J Am Soc Echocardiogr. 2020;33:1191–200.CrossRef
26.
go back to reference Edwards NFA, Scalia GM, Shiino K, Sabapathy S, Anderson B, Chamberlain R, et al. Global Myocardial Work Is Superior to Global Longitudinal Strain to Predict Significant Coronary Artery Disease in Patients With Normal Left Ventricular Function and Wall Motion. J Am Soc Echocardiogr. 2019;32:947–57.CrossRef Edwards NFA, Scalia GM, Shiino K, Sabapathy S, Anderson B, Chamberlain R, et al. Global Myocardial Work Is Superior to Global Longitudinal Strain to Predict Significant Coronary Artery Disease in Patients With Normal Left Ventricular Function and Wall Motion. J Am Soc Echocardiogr. 2019;32:947–57.CrossRef
28.
go back to reference Wang RR, Tian T, Li SQ, Leng XP, Tian JW. Assessment of Left Ventricular Global Myocardial Work in Patients With Different Degrees of Coronary Artery Stenosis by Pressure-Strain Loops Analysis. Ultrasound Med Biol. 2021;47:33–42.CrossRef Wang RR, Tian T, Li SQ, Leng XP, Tian JW. Assessment of Left Ventricular Global Myocardial Work in Patients With Different Degrees of Coronary Artery Stenosis by Pressure-Strain Loops Analysis. Ultrasound Med Biol. 2021;47:33–42.CrossRef
29.
go back to reference Hiemstra YL, van der Bijl P, El Mahdiui M, Bax JJ, Delgado V, Marsan NA. Myocardial Work in Nonobstructive Hypertrophic Cardiomyopathy: Implications for Outcome. J Am Soc Echocardiogr. 2020;33:1201–8.CrossRef Hiemstra YL, van der Bijl P, El Mahdiui M, Bax JJ, Delgado V, Marsan NA. Myocardial Work in Nonobstructive Hypertrophic Cardiomyopathy: Implications for Outcome. J Am Soc Echocardiogr. 2020;33:1201–8.CrossRef
30.
go back to reference Galli E, Vitel E, Schnell F, Le Rolle V, Hubert A, Lederlin M, et al. Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis. Echocardiography. 2019;36:74–82.CrossRef Galli E, Vitel E, Schnell F, Le Rolle V, Hubert A, Lederlin M, et al. Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis. Echocardiography. 2019;36:74–82.CrossRef
31.
go back to reference Roger-Rollé A, Cariou E, Rguez K, Fournier P, Lavie-Badie Y, Blanchard V, et al. Can myocardial work indices contribute to the exploration of patients with cardiac amyloidosis? Open Heart. 2020;7:e001346.CrossRef Roger-Rollé A, Cariou E, Rguez K, Fournier P, Lavie-Badie Y, Blanchard V, et al. Can myocardial work indices contribute to the exploration of patients with cardiac amyloidosis? Open Heart. 2020;7:e001346.CrossRef
33.
go back to reference Clemmensen TS, Eiskjær H, Mikkelsen F, Granstam SO, Flachskampf FA, Sørensen J, et al. Left Ventricular Pressure-Strain-Derived Myocardial Work at Rest and during Exercise in Patients with Cardiac Amyloidosis. J Am Soc Echocardiogr. 2020;33:573–82.CrossRef Clemmensen TS, Eiskjær H, Mikkelsen F, Granstam SO, Flachskampf FA, Sørensen J, et al. Left Ventricular Pressure-Strain-Derived Myocardial Work at Rest and during Exercise in Patients with Cardiac Amyloidosis. J Am Soc Echocardiogr. 2020;33:573–82.CrossRef
34.
go back to reference Meimoun P, Abdani S, Stracchi V, Elmkies F, Boulanger J, Botoro T, et al. Usefulness of Noninvasive Myocardial Work to Predict Left Ventricular Recovery and Acute Complications after Acute Anterior Myocardial Infarction Treated by Percutaneous Coronary Intervention. J Am Soc Echocardiogr. 2020;33:1180–90.CrossRef Meimoun P, Abdani S, Stracchi V, Elmkies F, Boulanger J, Botoro T, et al. Usefulness of Noninvasive Myocardial Work to Predict Left Ventricular Recovery and Acute Complications after Acute Anterior Myocardial Infarction Treated by Percutaneous Coronary Intervention. J Am Soc Echocardiogr. 2020;33:1180–90.CrossRef
35.
go back to reference Spetsotaki K, Zayat R, Donuru S, Autschbach R, Schnoering H, Hatam N. Evaluation of Left Ventricular Myocardial Work Performance in Patients Undergoing On-Pump and Off-Pump Coronary Artery Bypass Surgery. Ann Thorac Cardiovasc Surg. 2020;26:276–85.CrossRef Spetsotaki K, Zayat R, Donuru S, Autschbach R, Schnoering H, Hatam N. Evaluation of Left Ventricular Myocardial Work Performance in Patients Undergoing On-Pump and Off-Pump Coronary Artery Bypass Surgery. Ann Thorac Cardiovasc Surg. 2020;26:276–85.CrossRef
36.
go back to reference Lustosa RP, Fortuni F, van der Bijl P, Goedemans L, El Mahdiui M, Montero-Cabezas JM, et al. Left ventricular myocardial work in the culprit vessel territory and impact on left ventricular remodelling in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Eur Heart J Cardiovasc Imaging. 2020. https://doi.org/10.1093/ehjci/jeaa175.CrossRef Lustosa RP, Fortuni F, van der Bijl P, Goedemans L, El Mahdiui M, Montero-Cabezas JM, et al. Left ventricular myocardial work in the culprit vessel territory and impact on left ventricular remodelling in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Eur Heart J Cardiovasc Imaging. 2020. https://​doi.​org/​10.​1093/​ehjci/​jeaa175.CrossRef
37.
go back to reference Bouali Y, Donal E, Gallard A, Laurin C, Hubert A, Bidaut A, et al. Prognostic Usefulness of Myocardial Work in Patients With Heart Failure and Reduced Ejection Fraction Treated by Sacubitril/Valsartan. Am J Cardiol. 2020;125:1856–62.CrossRef Bouali Y, Donal E, Gallard A, Laurin C, Hubert A, Bidaut A, et al. Prognostic Usefulness of Myocardial Work in Patients With Heart Failure and Reduced Ejection Fraction Treated by Sacubitril/Valsartan. Am J Cardiol. 2020;125:1856–62.CrossRef
38.
go back to reference Valentim Gonçalves A, Galrinho A, Pereira-da-Silva T, Branco L, Rio P, Timóteo AT, et al. Myocardial work improvement after sacubitril-valsartan therapy: a new echocardiographic parameter for a new treatment. J Cardiovasc Med (Hagerstown). 2020;21:223–30.CrossRef Valentim Gonçalves A, Galrinho A, Pereira-da-Silva T, Branco L, Rio P, Timóteo AT, et al. Myocardial work improvement after sacubitril-valsartan therapy: a new echocardiographic parameter for a new treatment. J Cardiovasc Med (Hagerstown). 2020;21:223–30.CrossRef
39.
go back to reference Manganaro R, Marchetta S, Dulgheru R, Sugimoto T, Tsugu T, Ilardi F, et al. Correlation between non-invasive myocardial work indices and main parameters of systolic and diastolic function: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2020;21:533–41.CrossRef Manganaro R, Marchetta S, Dulgheru R, Sugimoto T, Tsugu T, Ilardi F, et al. Correlation between non-invasive myocardial work indices and main parameters of systolic and diastolic function: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2020;21:533–41.CrossRef
40.
go back to reference Halabi A, Wright L, Marwick TH. Measurement of Global Myocardial Work with Exercise Testing. J Am Soc Echocardiogr. 2020;33:631–2.CrossRef Halabi A, Wright L, Marwick TH. Measurement of Global Myocardial Work with Exercise Testing. J Am Soc Echocardiogr. 2020;33:631–2.CrossRef
41.
go back to reference Mansour MJ, AlJaroudi W, Mansour L, Nehme A, Hamoui O, Ayoub W, et al. Value of myocardial work for assessment of myocardial adaptation to increased afterload in patients with high blood pressure at peak exercise. Int J Cardiovasc Imaging. 2020;36:1647–56.CrossRef Mansour MJ, AlJaroudi W, Mansour L, Nehme A, Hamoui O, Ayoub W, et al. Value of myocardial work for assessment of myocardial adaptation to increased afterload in patients with high blood pressure at peak exercise. Int J Cardiovasc Imaging. 2020;36:1647–56.CrossRef
Metadata
Title
Afterload-related reference values for myocardial work indices
Authors
Qiancheng Li
Hui Wang
Haiyan Feng
Tingfan Wu
Ying Yang
Dongmei Gao
Lina Sun
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2021
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/s12947-021-00253-2

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