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Value of myocardial work for assessment of myocardial adaptation to increased afterload in patients with high blood pressure at peak exercise

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Abstract

Non-invasive myocardial work (MW) indices are superior to global longitudinal strain (GLS) to assess left ventricular (LV) mechanics in situations where afterload is abnormally high. The rotational motion of the apex provides an accurate index of LV contractility. To date, there are no data about MW values during stress echocardiography (SE), particularly for the apex. Our study aims at assessing MW indices at peak exercise to better understand LV mechanics in patients with high peak systolic blood pressure (SBP). A total of 81 patients without structural or ischemic heart disease referred for SE between January and June 2019 were included. BP measurements, GLS and MW indices were performed at rest and peak exercise. In order to quantify the role of the apex, apical work fraction (AWF) was also calculated and further stratified by peak SBP. A peak SBP > 180 mmHg was considered abnormally high. There were 36 (44%) patients who had peak SBP > 180 mmHg. They showed similar resting GLS and MW values when compared to control. However, peak stress global work index, constructive work and wasted work (GWW) increased significantly (P-value < 0.05), with a relatively constant global work efficiency. In the multivariate analysis, peak SBP > 180 mmHg was associated with threefold increased odds of abnormal peak GWW > 96.5 mmHg% (median value) (odds ratio 3.0, P-value 0.003). Apical work increased significantly when stratified by peak SBP (P-value 0.003) and AWF increased from 33 ± 3% to 37 ± 3% (rest-stress), P-value < 0.0001, but remained constant when stratified by peak SBP. Our analysis provides new data on MW indices at peak stress, particularly for patients with abnormal peak SBP response, and supports the role and the contribution of the apex to MW.

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Abbreviations

EF:

Ejection fraction

GLS:

Global longitudinal strain

GCW:

Global constructive work

GWE:

Global work efficiency

GWI:

Global work index

GWW:

Global wasted work

HR:

Heart rate

IVRT:

Isovolumic relaxation time

LV:

Left ventricle

MVC:

Mitral valve closure

MVO:

Mitral valve opening

PSL:

Pressure-strain loop

SBP:

Systolic blood pressure

SE:

Stress echocardiography

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Acknowledgements

The authors deeply thank the cardiac sonographers and nurses working at the echocardiography laboratory of Clemenceau Medical Center for their skilful assistance, particularly Mrs. Nada Khoury, RCS.

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Author notes

  1. Mohamad Jihad Mansour and Wael AlJaroudi have contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, Lebanese University Faculty of Medical Sciences, Hadath, Lebanon

    Mohamad Jihad Mansour, Layal Mansour & Elie Chammas

  2. Division of Cardiovascular Medicine, Clemenceau Medical Center Affiliated With Johns Hopkins International, Beirut, Lebanon

    Mohamad Jihad Mansour, Wael AlJaroudi, Omar Hamoui, Wadih Ayoub & Elie Chammas

  3. Department of Internal Medicine, Lebanese University Faculty of Medical Sciences, Hadath, Lebanon

    Amal Nehme

Authors
  1. Mohamad Jihad Mansour
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  2. Wael AlJaroudi
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  3. Layal Mansour
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  4. Amal Nehme
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  5. Omar Hamoui
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Correspondence to Elie Chammas.

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Mansour, M.J., AlJaroudi, W., Mansour, L. 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 36, 1647–1656 (2020). https://doi.org/10.1007/s10554-020-01867-9

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