Abstract
Echocardiographic assessment of left ventricular ejection fraction (LVEF) is essential in the investigation and ongoing management of heart failure. The conventional measure of LVEF may not reflect the complexity of the dynamics associated with ventricular function particularly in patients with heart failure with preserved ejection fraction (HFpEF). Novel echocardiographic measures of myocardial work indices (MWI) have shown promise in providing insights in HFpEF. We aimed to examine the utility of MWI in HFpEF patients. A comprehensive search of online databases from the year 2005 to June 2021 using search concepts “Myocardial work”, “Heart failure”, “Echocardiography” and “pressure-strain loop” were assessed using the PRISMA strategy. A total of 23 full texts met inclusion criteria, of which 17 were excluded and 6 were analysed. Our results demonstrate significant variation in myocardial work parameters in patients with different aetiologies of HFpEF. Global constructive work (GCW) was reduced in those with cardiac amyloidosis and hypertrophic cardiomyopathy (HCM). Conversely, GCW was increased in patients with hypertension. Global wasted work was not significantly increased in those with hypertension or HCM. These variations suggest potential utility of MWI in providing insight into the changes myocardial energetics that occur with the spectrum of diseases resulting in HFpEF. The effect of small study populations limited the broad application of these findings. MWI shows promise as a novel echocardiographic tool in assessing the variations of myocardial energetics in HFpEF.
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