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Association between left ventricular geometry and global myocardial work in patients with heart failure with preserved ejection fraction: assessment using strain-pressure loop

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Abstract

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. 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. HFpEF patients showed lower GWE (94% vs 96%, P < 0.001) and higher GWW (114 mmHg% vs 78 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 (94% vs 95%, P = 0.034) 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. Impaired global myocardial work was detected in patients with HFpEF. Impaired LV GMW may be associated with increased RWT.

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Data availability

All data generated or analysed during this study are included in this published article (and its supplementary information files). The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

LVEF:

Left ventricular ejection fraction

GLS:

Global longitudinal strain

GMW:

Global myocardial work

GWI:

Global work index

GCW:

Global constructive work

GWW:

Global waste work

GWE:

Global work efficiency

RWT:

Relative wall thickness

LVMi:

Left venricular mass index

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Acknowledgements

We thank all subjects for their participation and other colleagues for their support.

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The authors have not disclosed any funding.

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Author notes

  1. Qizhe Cai and Xiuzhang Lu have contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China

    Mingming Lin, Yunyun Qin, Xueyan Ding, Miao Zhang, Weiwei Zhu, Chenlei Leng, Xiuzhang Lu & Qizhe Cai

  2. GE Clinical Education Team, Beijing, 100176, China

    Jiangtao Wang

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  1. Mingming Lin
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Contributions

CQZ and LXZ conceived and designed the research; LMM, QYY, DXY, ZM and ZWW collected data and conducted the research; LMM, LCL and WJT analyzed and interpreted the data; LMM wrote the initial paper; CQZ revised the paper; CQZ approved the final version to be submitted. LMM had primary responsibility for the final content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xiuzhang Lu or Qizhe Cai.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All study participants provided informed consent, and the study design was performed in line with the Declaration of Helsinki and approved by the ethics committee of Beijing Chaoyang Hospital Affiliated to Capital Medical University (No: 2021-11-26-17). All methods in our study were carried out in accordance with relevant guidelines and regulations in the Ethics approval.

Consent to participate

All study participants provided informed consent, and the study design was performed in line with the Declaration of Helsinki and approved by the ethics committee of Beijing Chaoyang Hospital Affiliated to Capital Medical University (No: 2021-11-26-17).

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Lin, M., Qin, Y., Ding, X. et al. Association between left ventricular geometry and global myocardial work in patients with heart failure with preserved ejection fraction: assessment using strain-pressure loop. Int J Cardiovasc Imaging 39, 319–329 (2023). https://doi.org/10.1007/s10554-022-02731-8

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