Correlation of left ventricular myocardial work indices with invasive measurement of stroke work in patients with advanced heart failure

Federico Landra; Giulia Elena Mandoli; Benedetta Chiantini; Maria Barilli; Giacomo Merello; Giuseppe De Carli; Carlotta Sciaccaluga; Matteo Lisi; Filippo Flamigni; Flavio D'Ascenzi; Marta Focardi; Massimo Fineschi; Alessandro Iadanza; Sonia Bernazzali; Massimo Maccherini; Serafina Valente; Matteo Cameli

doi:10.3389/fcvm.2022.946540

Correlation of left ventricular myocardial work indices with invasive measurement of stroke work in patients with advanced heart failure

Front Cardiovasc Med. 2022 Oct 17:9:946540. doi: 10.3389/fcvm.2022.946540. eCollection 2022.

Authors

Federico Landra¹, Giulia Elena Mandoli¹, Benedetta Chiantini¹, Maria Barilli¹, Giacomo Merello¹, Giuseppe De Carli¹, Carlotta Sciaccaluga¹, Matteo Lisi^{1

2}, Filippo Flamigni^{2

3}, Flavio D'Ascenzi¹, Marta Focardi¹, Massimo Fineschi⁴, Alessandro Iadanza⁴, Sonia Bernazzali⁵, Massimo Maccherini⁵, Serafina Valente¹, Matteo Cameli¹

Affiliations

¹ Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
² Department of Cardiovascular Diseases-Azienda Unitá Sanitaria Locale (AUSL) Romagna, Division of Cardiology, Ospedale Santa Maria delle Croci, Ravenna, Italy.
³ Cardiology Unit and Laboratorio per le Tecnologie delle Terapie Avanzate (LTTA) Centre, University of Ferrara, Ferrara, Italy.
⁴ Interventional Cardiology, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy.
⁵ Department of Cardiac Surgery, University of Siena, Siena, Italy.

Abstract

Objectives: This study aimed to explore the correlation between left ventricular (LV) myocardial work (MW) indices and invasively-derived LV stroke work index (SWI) in a cohort of patients with advanced heart failure (AHF) considered for heart transplantation.

Background: Left ventricular MW has emerged as a promising tool for diagnostic and prognostic purposes in heart failure (HF) but its relationship with hemodynamic data derived from right heart catheterization (RHC) has not been assessed in patients with advanced heart failure yet.

Materials and methods: Consecutive patients with AHF considered for heart transplantation from 2016 to 2021 performing RHC and echocardiography as part of the workup were included. Conventional LV functional parameters and LV MW indices, including LV global work index (GWI), LV global constructive work (GCW), LV global wasted work (GWW), LV global work efficiency (GWE), and other were calculated and compared with invasively-measured LV SWI.

Results: The population included 44 patients. Median time between RHC and echocardiography was 0 days (IQR: 0-24). Median age was 60 years (IQR: 54-63). For the most part, etiology of HF was non-ischemic (61.4%) and all patients were either on class NYHA II (61.4%) or III (27.3%). Median left ventricular ejection fraction was 25% (IQR: 22.3-32.3), median NT-proBNP 1,377 pg/ml (IQR: 646-2570). LV global longitudinal strain (GLS) significantly correlated with LV SWI (r = -0.337; p = 0.031), whereas, LV ejection fraction (EF) did not (r = 0.308; p = 0.050). With regard to LV MW indices, some of them demonstrated correlation with LV SWI, particularly LV GWI (r = 0.425; p = 0.006), LV GCW (r = 0.506; p = 0.001), LV global positive work (LV GPW; r = 0.464; p = 0.003) and LV global systolic constructive work (GSCW; r = 0.471; p = 0.002).

Conclusion: Among LV MW indices, LV GCW correlated better with invasively-derived SWI, potentially representing a powerful tool for a more comprehensive evaluation of myocardial function.

Keywords: advanced echocardiography; advanced heart failure; left ventricle; myocardial work; right heart catheterization; speckle tracking analysis; speckle tracking echocardiography; stroke work.