Impact of peak strain dispersion and septal flash on left ventricular myocardial work in patients with complete left bundle branch block.

Septal flash (SF) serves as a hallmark of ventricular contraction dyssynchrony in Complete left bundle branch block (CLBBB). This study employed pressure-strain loop (PSL) analysis via echocardiography to quantitatively assess left ventricular (LV) myocardial work in patients with CLBBB. The investigation aimed to elucidate the impact of asynchronous contraction patterns on myocardial mechanical function. 80 patients with CLBBB were categorized into GroupⅠ(non-SF, n=31) and GroupⅡ(SF, n=49). Additionally, 40 age- and sex-matched controls with normal electrocardiograms was recruited. Global constructive work (GCW), global waste work (GWW), global work efficiency (GWE), and global work index (GWI) were assessed in all participants. Myocardial work parameters were calculated for 6 LV segments, as well as the ratios of the septum-to-free-wall. Compared with controls, CLBBB patients had increased GWW as well as waste work (WW) in all segments, and decreased GWE, GWI, and individual segmental work efficiency (WE) (P<0.05). Compared with non-SF, patients with SF had increased GWW, significantly decreased GWE, GWI, GCW (P<0.05). The septal-to-free-wall ratios of constructive work (CW), work index (WI), and WE were all significantly reduced, accompanied by increased WW in anterior and posterior septal (P<0.05). SF was confirmed as an independent risk factor for reduced LV systolic function (GWI<2010 mmHg%) in CLBBB (OR=4.582; P=0.010) by multivariate logistic regression analysis. Myocardial work assessment provides an accurate evaluation of LV systolic function in CLBBB patients. Those with SF will waste more energy and are more likely to have impaired myocardial contractility.

This study aimed to analyze myocardial work in patients with atrial fibrillation (AF) using a noninvasive pressure strain loop (PSL) technique to provide a basis for the quantitative assessment of left ventricular (LV) systolic function. LV myocardial work of 107 AF patients (56 with paroxysmal atrial fibrillation and 51 with persistent atrial fibrillation) and 55 healthy individuals were assessed by the noninvasive PSL and then compared. Global longitudinal strain (GLS) in absolute values, global work index (GWI), global constructive work (GCW), and global work efficiency (GWE) were significantly lower in the AF group than control group, whereas peak strain dispersion (PSD) and global wasted work (GWW) were significantly higher (P<.05). Further subdivision according to the AF type revealed that, compared with the controls, GLS in absolute values and GWE decreased significantly; PSD and GWW increased significantly in the paroxysmal AF group (P<.05). Nevertheless, GWI and GCW were not significantly different between paroxysmal AF and control groups (P>.05). Compared to paroxysmal AF, persistent AF induced a further decrease in absolute GLS and GWE and a further increase in GWW (P<.05), but PSD did not increase further (P>.05). Multiple linear regression analysis showed that GWI and GCW were independently associated with systolic blood pressure. GWW was associated with types of AF and left atrial volume index (LAVI). GWE was correlated with age, types of AF, disease duration, and LAVI. Receiver operating characteristic curve analysis showed that the area under the curve predicting myocardial injury was higher for GWE and GWW than for GLS (area under the curve: .880, .846, and .821, respectively). Non-invasive PSL can quantitatively assess LV systolic function in patients with different kinds of AF and detect early subclinical myocardial injury in patients with paroxysmal AF. GWE and GWW outperform GLS and LV ejection fraction when assessing myocardial injury. Systolic blood pressure, type of AF, LVAI, disease duration, and age may be associated with myocardial injury in patients with AF.

To investigate the value of the noninvasive pressure-strain loop (PSL) technique for assessing left ventricular myocardial work done in patients with essential hypertension. Prospectively, 60 patients with hypertension visiting the hospital from August 2020 to July 2021 were collected and divided into the mild hypertension group (SBP 140-159 mmHg, 35 cases) and the moderate-to-severe hypertension group (SBP ≥160 mmHg, 25 cases). Another 40 cases of healthy adults were collected as the control group. The differences in the global long-axis strain (GLS) and peak strain dispersion (PSD) of the left ventricle, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were compared among the three groups. The receiver operating characteristic curve was used to evaluate the PSD, GWI, GCW, and GWW. The myocardial work index (MWI) and MWI percentages in the apical, middle, and basal segments of the heart were also compared among the groups. (1) The PSD, GWI, GCW, and GWW were significantly different among the groups (Χ2 =57.605, 79.203, 76.973, and 17.429, respectively, p < .05), while the GLS and GWE were not (Χ2 =1.559 and 5.849, respectively, p > .05). (2) The GWI had the highest specificity (97.5%) and the GCW the highest sensitivity (95%) in predicting hypertension. The percentage of apical MWI gradually increased (F=11.230, p < .05) and the percentage of basal MWI gradually decreased (F=10.665, p < .05) from the control group to the mild hypertension group to the moderate-to-severe hypertension group; there was no significant difference in the percentage of mid-MWI (F=0.593, p > .05). The noninvasive PSL technique could be used to assess myocardial work done in patients with essential hypertension.

Noninvasive myocardial work (MW) is a new technology which is based on strain after considering the load influence on myocardial deformation. We aimed to investigate the feasibility of quantitatively assessing left ventricular myocardial work (LVMW) in patients with systemic lupus erythematosus (SLE) using a left ventricular pressure-strain loop (LVPSL). 76 patients with SLE were included in the study (A), further divided into two subgroups according to the presence of lupus nephritis (LN). Global longitudinal strain (GLS), peak strain dispersion (PSD), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained. 1: Patients with SLE demonstrated a significantly reduced GWE and GLS compared with control group, GWW and PSD were increased, above changes were more pronounced in patients with LN. There was no significant difference in GWI and GCW. 2: Receiver operating characteristic (ROC) analysis demonstrated that GWE was the most powerful tool for detecting myocardial insufficiency early in SLE patients, and the area under the curve (AUC) was 0.804, and was superior to GLS (AUC = 0.707). GWE remains the best indicator of subclinical myocardial injury in patients with LN. The AUC was 0.910, and the best cutoff point was 96.5% (sensitivity 83.3%, specificity 73.3%). LVPSL can be used to noninvasively assess changes in MW in patients with SLE. Noninvasive GWE is a more sensitive index than GLS to detect subclinical myocardial injury early in SLE patients. This is a potential valuable clinical tool to assist in the early-find myocardial damage.

Objective To quantitatively evaluate the changes of left ventricular myocardial work indices by pressure-strain loops (PSL) using echocardiography in patients undergoing coronary artery bypass grafting (CABG). Methods Thirty patients undergoing CABG from October 2018 to May 2019 in Henan Provincial People′s Hospital were chosen as the case group, and 30 healthy subjects were selected as the control group. The myocardial work indices of left ventricle, including global work index (GWI), global constructive work (GCW), global work waste (GWW) and global work efficiency (GWE) were measured by PSL, the differences in myocardial work indices between the two groups, including controls, patients before surgery, 1 month, and 3 months after CABG were compared. Results Compared with the control group, GWI, GCW, GWE of the left ventricle in each case groups were decreased before and after CABG, while GWW was increased significantly(all P 0.05), while GWI, GWE of left ventricle of the postoperative 3-month were increased, and the differences were statistically significant (all P<0.05); the differences of GWI, GCW, GWE between the postoperative 1-month and 3-month were statistically significant (all P<0.05). GWI, GCW, GWW, GWE were significantly related to left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS) (all P=0.00). Bland-Altman drawing plots showed that the measurements of GWI, GCW, GWW, GWE between the observers and within the same observer exhibited good reproducibility. Conclusions PSL can quantitatively evaluate left ventricular myocardial work and provide a new method for the evaluation of left ventricular systolic function in patients undergoing CABG. Key words: Echocardiography; Coronary heart disease; Coronary artery bypass grafting; Myocardial work; Left ventricular systolic function

Objective: To investigate the diagnosis value of myocardial work (MW) in evaluating left ventricular global systolic function among acute myocardial infarction (AMI) patients with preserved ejection fraction (LVEF). Methods: This study was a diagnostic trial in a prospective case-control design. AMI patients with preserved LVEF were enrolled as AMI(LVEF>50%) group and age and sex-matched healthy individuals undergoing healthy checkup in our hospital were collected as control group. Two-dimensional dynamic images, including standard apical two-chamber, long-axis and four-chamber views in 3 consecutive cardiac cycles were acquired. General clinical data, routine echocardiography and myocardial work parameters were obtained from all subjects. The indices were compared between the two groups. Intra-observer and inter-observer repeatability of myocardial work parameters were evaluated by intra-group correlation coefficient (ICC). Receiver operator characteristic (ROC) curve was used to determine the diagnostic value of global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global work index (GWI) on the reduction of left ventricular global systolic function in AMI(LVEF>50%) group. Results: There were 30 patients in AMI(LVEF>50%) group, the age was (67.3±9.7)years, and 14 cases were female(46.7%). Thirty participants were included in the control group, the age was (68.1±8.6)years, and 12 cases were female (40.0%). Compared with the control group, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septum thickness (IVSD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), peak early diastolic velocity of mitral orifice/tissue Doppler velocity of posterior mitral annulus (E/e), left ventricular mass (LVM), left ventricular mass index (LVMI) were significantly higher, while E and e values were significantly lower in AMI (LVEF>50%) group (all P<0.05). Compared with the control group, GCW ((1 145.9±440.1)mmHg% (1 mmHg=0.133 kPa) vs. (1 425.7±355.4)mmHg%), GWE ((80.9±9.5)% vs. (87.3±5.5)%), GWI ((1 001.3±416.2)mmHg% vs. (1 247.6±341.7)mmHg%) and the absolute value of long axis integral strain (GLS) ((8.5±3.4)% vs. (11.4±3.7)%) were significantly lower, while peak strain dispersion(PSD)((101.3±66.4)ms vs. (74.7±31.9)ms) was significantly higher in AMI(LVEF>50%) group (P all<0 05). There was no significant difference in GWW((177.2±71.1)mmHg% vs. (155.7±64.6)mmHg%) between the two groups (P>0.05). The reproducibility of GCW, GWW, GWE and GWI within and between observers were satisfactory (all ICC>0.75). ROC curve analysis showed that all four parameters, GCW, GWW, GWE, and GWI, could be used for the diagnosis of reduced left ventricular systolic function in patients with AMI (LVEF>50%), and their areas under the ROC curve were 0.896,0.929,0.808,0.862. Conclusion: Myocardial work assessment is valuable on diagnosing left ventricular global systolic function reduction in AMI patients with preserved LVEF.

Introduction: A new and noninvasive technology of left ventricular pressure-strain loop (LV-PSL) has recently been used to provide information on myocardial work (MW) and identify subtle modifications in cardiac function. This study aimed to use LV-PSL for early identification of changes in left ventricular (LV) structure and MW in patients with end-stage renal disease (ESRD). Methods: Seventy-two patients with ESRD were divided into two groups based on undergoing maintenance hemodialysis (MHD), namely, the dialysis group (ESRD-D group) and non-dialysis group (ESRD-ND group). Thirty age- and sex-matched control participants were enrolled in the N group. Traditional echocardiography and LV-PSL measurements were conducted. The values of global longitudinal strain (GLS), peak strain dispersion (PSD), global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE) were assessed. Results: The most prevalent anomaly in ESRD patients was LV hypertrophy. The GLS value was significantly lower, and PSD was higher in patients with ESRD than in controls. Furthermore, patients with ESRD had severely higher GWW values and lower GWE than the N group (p < 0.05). No significant differences were found in GWI and GCW between the three groups (p > 0.05). Correlation analysis showed that GCW, GWI, and GWE were positively correlated with LV ejection fraction (EF) and negatively correlated with GLS. GWW was negatively correlated with LVEF and positively correlated with GLS and PSD. In addition, GWE was negatively correlated with PSD (all p < 0.05). Conclusions: Patients with ESRD have LV structural and functional abnormalities. LV-PSL measurement can be helpful in identifying these subclinical abnormalities. MHD did not change myocardial workload in patients with ESRD.

Objective: To quantitatively evaluate left ventricular myocardial work in patients with mitral valve prolapse with severe regurgitation (MVPSR) and normal left ventricular ejection fraction (LVEF) using pressure-strain loop (PSL) technology, and explore its predictive value for the duration of patients' postoperative stay in the intensive care unit (ICU). Methods: MVPSR patients with normal LVEF who were treated at Fuwai Huazhong Cardiovascular Hospital from May 2023 to June 2025 were included as the MVPSR group. All patients underwent cardiac valve repair or valve replacement surgery and underwent echocardiography before surgery. Subjects who were matched for gender, age, body mass index as well as comorbidities, and underwent echocardiography during the same period, and were excluded from MVPSR were selected as the non-MVPSR group. Left ventricular global longitudinal strain, longitudinal strain peak time dispersion and global work index, global work efficiency (GWE), global constructive work, global wasted work, as well as the longitudinal strain and work parameters for each segment (basal, mid, and apical segments) were assessed using PSL technology. The duration of ICU stay for patients in the MVPSR group after mitral valve surgery were recorded, and a prolonged ICU stay was defined as a duration >48 hours. The differences in left ventricular myocardial work parameters between the two groups were compared, and the impact of GWE on the duration of patients' early postoperative ICU stay was analyzed using a multifactor linear regression model. Receiver operating characteristic curve analysis was applied to evaluate the predictive performance of GWE for prolonged ICU stay. Results: There were 80 patients in the MVPSR group, aged (58.9±12.3) years, including 61 males. There were 58 patients in the non-MVPSR group, including 31 healthy subjects, aged (54.8±15.3) years, including 36 males. The postoperative ICU stay time in the MVPSR group was (37.0±16.8) hours. Compared with the non-MVPSR group, the MVPSR group had lower global work index, GWE and global constructive work, and higher global wasted work; the work efficiency and constructive work in the basal, intermediate and apical segments were all lower, and the wasted work was higher; the longitudinal strain and work index in the basal segment were both lower (all P<0.05). The results of the multi-factor linear regression model analysis showed that GWE was an independent influencing factor for postoperative ICU stay duration in MVPSR patients (β=-2.89, 95%CI -5.43--0.34, P=0.030). The area under the curve for GWE in predicting prolonged ICU stay time was 0.850 (95%CI 0.729-0.970). The receiver operating characteristic curve showed that the optimal cutoff value for GWE for predicting prolonged ICU stay was 92.5%, namely GWE≤92.5% predicting prolonged stay in ICU, with a sensitivity of 76.2% and a specificity of 82.4%. Conclusions: Patients with MVPSR and normal LVEF exhibit varying degrees of alterations in global and segmental left ventricular myocardial work parameters. GWE is negatively correlated with postoperative ICU length of stay and has certain predictive value for prolonged ICU stay after surgery.

To evaluate the effect of immune checkpoint inhibitors (ICIs) on left ventricular myocardial work by pressure-strain loop (PSL). Forty-three immunotherapy patients were enrolled in the case group, and another 43 healthy volunteers were enrolled in the control group. They were examined by echocardiography before immunotherapy (T0 phase), after three cycles of treatment (T3 phase) and after six cycles of treatment (T6 phase). Conventional echocardiographic parameters, left ventricular global longitudinal strain (GLS), and myocardial work indices, including global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE), were collected for analysis to compare the results of the different immunotherapy cycles. There were no statistically significant differences of baseline characteristics, conventional echocardiographic parameters, left ventricular strain, and myocardial work indices between T0 phase and control group (all p>.05). There were no statistically significant differences in LVEF between T0, T3, and T6 phase (all p>.05). GLS, GWI, GCW, and GWE were decreased and GWW was increased in T3 and T6 phase. There were no statistically significant difference between GLS in T3 and T0 phase (q=.9057, p>.05). The difference was statistically significant between GLS in T6 and T0 phase (q=5.5651, p<.01). The difference was statistically significant between GLS in T3 and T6phase(q=4.6594, p<.01). There were statistically significant difference in GWI, GCW, GWE, and GWW in the T3 and T6 phase compared with the T0 phase (p<.01). PSL can effectively evaluate the effect of ICIs on left ventricular myocardial work, to provide a new method for the early clinical detection of ICIs-related cardiotoxicity.

Noninvasive left ventricular pressure-strain myocardial work (MW) is a novel method for evaluating left ventricular function that integrates myocardial deformation and afterload and has certain advantages over global longitudinal strain (GLS). The study aimed to analyze MW in patients with well-functioning bicuspid aortic valve (BAV) and explore the influences of aortic dilation and arterial stiffness on left ventricular function. A total of 104 patients with well-functioning BAVs and 50 controls were enrolled in our study. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), GLS, and aortic stiffness index were measured. Based on the ascending aortic diameter, patients with BAV were divided into 3 subgroups (nondilated, mildly dilated, and moderately dilated). GWI, GCW, GWW, and aortic stiffness index were significantly increased (P<0.001, P=0.023, P<0.001, and P<0.001, respectively), while GWE and GLS were significantly decreased among patients with BAV compared with controls (all P values <0.001). Patients with BAV and mildly and moderately dilated aortas had an increased GWW and aortic stiffness index but a decreased GWE compared with patients with BAV and nondilated aortas (all P values <0.05); meanwhile, GCW and GLS did not differ among the BAV subgroups (all P values >0.05). GWI was elevated in patients with BAV and moderately dilated aortas compared with patients with BAV and nondilated aortas (P<0.05). On multivariable analysis, the aortic stiffness index was an independent influencer of GWI, GCW, GWW, and GWE (P=0.025, P=0.049, P<0.001, and P=0.001, respectively). The aortic diameter was highly correlated with the aortic stiffness index (r=0.863; P<0.001). MW could assess early myocardial impairment in patients with well-functioning BAV. MW may help to differentiate the detrimental effect of aortic dilation on left ventricular function, whereas GLS may not.

Myocardial work (MW) is a novel indicator measured by noninvasive echocardiography, which could detect subclinical myocardial dysfunction before reduction of left ventricular ejection fraction (LVEF). The study aimed to evaluate subclinical myocardial dysfunction in patients with systemic sclerosis (SSc) with normal LVEF, using left ventricular MW through two-dimensional speckle-tracking imaging (2D-STI). Eighty patients with SSc, which included 40 diffuse skin type SSc (dcSSc) and 40 limited skin type SSc (lcSSc) according to LeRoy's criteria, and 40 gender and age matched health subjects were enrolled. The images were collected using standard transthoracic echocardiography. Global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained. Our study showed that there were no significant differences in LVEF and GLS between the SSc group and the control group. Both the lcSSc group and the dcSSc group had lower GWI, GCW, and GWE and higher GWW than the control group (P < 0.05). GWI, GCW, and GWE were lower in the dcSSc group than those in the lcSSc group, while GWW was higher in the dcSSc group (P < 0.05). GWI and GCW were positively correlated with LVEF (P < 0.001). GWI, GCW, and GWE were negatively correlated with GLS (P < 0.001), and GWW was positively correlated with GLS (P < 0.05). Elevated CRP was associated with reduced GWI and GCW (P < 0.05). Our study demonstrates the presence of subclinical myocardial dysfunction in SSc patients. The dcSSc patients may be more prone to have subclinical myocardial dysfunction than the lcSSc patients. Noninvasive left ventricular myocardial work may be a promising novel tool for detection of subclinical myocardial dysfunction.

Introduction A new non-invasive technology for the assessment of left ventricular myocardial work (LVMW) is based on speckle-tracking echocardiography and considers LV pressure. Changes in LVMW are described in patients with different cardiovascular diseases. In patients with chronic heart failure (CHF), LVMW is associated with long-term prognosis and favorable response to cardiac resynchronization therapy. Purpose To study echocardiographic parameters, including LVMW, in patients with CHF receiving cardiac contractility modulation therapy. Methods The study included 40 patients (31 men and 7 women) aged 60.5 [55.0; 66.0] years with heart failure with reduced ejection fraction (NYHA class II or III) in combination with atrial fibrillation. Before implantation of cardiac contractility modulation (CCM) device and 2, 6 and 12 months after, the patients underwent transthoracic echocardiography with an assessment of the main structural and functional parameters. Also, initially and after 12 months of CCM therapy, an assessment of global longitudinal strain (GLS) and LVMW was performed (global work index (GWI), global constructive work (GCW), global wasted work, global work efficiency (GWE)). Results Initially, the patients included in the study had enlarged left heart chambers and decreased left ventricular ejection fraction (LVEF). CCM therapy was accompanied by significant increase in LVEF from 30.0 [26.5; 37.0]% before device implantation up to 34.4 [27.0; 40.0]% (p=0.016) after 2 months and up to 38.0 [30.5; 42.0]% (p&amp;lt;0.01) after 6 months of treatment. One year after device implantation, a significant increase in LVEF was maintained as compared with initial data (39 [31; 45]%, p&amp;lt;0.01). We also analyzed the dynamics of echocardiographic parameters depending on etiology of CHF (ischemic and non-ischemic). As in general group of patients regardless of CHF etiology there was a significant increase in LVEF, that reached maximum values after 12 months of therapy (36 [30; 42]% in group with ischemic etiology, p&amp;lt;0.01 and 37 [30; 45]% in group with non-ischemic etiology, p&amp;lt;0.01). The assessment of GLS before and 12 months after device implantation revealed no significant dynamics (−7 [−9; −4]% and −8 [−9; −5]%, p=0.93). However, we observed significant changes in LVMW: an increase in GWI from 429 [332; 744] to 635 [401; 815] mm Hg% (p=0.01) and GWE (from 73 [68; 79] to 74 [70; 87] %, p=0.02) due to an increase in GCW (from 791 [530; 1031] to 836 [708; 1109] mm Hg%, p=0.03). Conclusions A significant increase in LVEF, GWI and GWE in patients with CHF (NYHA class II or III) receiving CCM therapy indicates an improvement in LV systolic function and the effectiveness of CCM therapy. The modern echocardiographic technologies open great opportunities for detailed assessment of the effectiveness of treatment of patients with CHF, including the use of CCM devices. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of Russian Federation

(1) Objective: To evaluate myocardial injury by observing the different parameters of global myocardial work (MW) by left ventricular pressure-strain loop (PSL) analysis in patients with chronic kidney disease (CKD). (2) Methods: According to the left ventricular mass index, the study patients with CKD were further divided into two groups: the left ventricular normal group (CKDN-LVH, 59) and left ventricular hypertrophy group (CKDLVH, 46). Thirty-three healthy controls (CON) matched in age and sex with the CKD group were recruited. The routine ultrasonic parameters were obtained by routine TTE, and the strain index and different parameters of the left ventricular MW were obtained by dynamic image offline analysis. (3) Results: This study found that (1) compared with the CON group, the CKDN-LVH group had a significantly increased global waste work (GWW) and significantly decreased global work efficiency (GWE), the GWW further increased, and GWE further decreased in the CKDLVH group. There was no significant change in the global work index (GWI) and global constructive work index (GCW) in the CKDN-LVH group, but the GWI and GCW in the CKDLVH group were significantly increased. (2) According to the grouping analysis of systolic blood pressure (SBP), we found that the GWW increased and GWE decreased in CKD patients with an elevated SBP. (3) Correlation analysis showed that the increase of the peak strain dispersion, SBP, and left ventricular mass index and the decrease of the estimated glomerular filtration rate were significantly correlated with the decrease of the GWE and the increase of the GWW. (4) Receiver operating characteristic curve analysis showed that the area under the curve (AUC) of myocardial damage induced by the GWE and GWW in the CKD group and CON group was higher than that of left ventricular global longitudinal strain (AUCs: 0.87 and 0.878 versus 0.72, respectively). (4) Conclusions: Noninvasive left ventricular PSL analysis can be used to evaluate the global MW in patients with CKD. The study justified the role of GWW in the noninvasive assessment of myocardial function in patients with CKD.

The prompt and precise identification of hemodynamically significant coronary artery lesions remains an ongoing challenge. This study investigated the diagnostic value of non-invasive global left ventricular myocardial work indices by echocardiography in functional status of coronary artery disease (CAD) patients with myocardial ischemia using fractional flow reserve (FFR) as the gold standard. A total of 77 consecutive patients with clinically suspected CAD were prospectively enrolled. All participants sequentially underwent echocardiography, invasive coronary angiography (ICA) and FFR measurement. According to the results of ICA, patients were divided into myocardial ischemia group (FFR ≤ 0.8, n = 27) and non-myocardial ischemia group (FFR > 0.8, n = 50). Myocardial work indices including global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), global positive work (GPW), global negative work (GNW), global systolic constructive work (GSCW) and global systolic wasted work (GSWW) were obtained by using the non-invasive left ventricular pressure strain loop (PSL) technique. Compared with the non-myocardial ischemia group, GWI, GCW, GPW and GSCW were significantly decreased in the myocardial ischemia group at either the 18-segment level or the 12-segment level (P < 0.001). At the 18-segment level, GWI < 1783.6 mmHg%, GCW < 1945.4 mmHg%, GPW < 1788.7 mmHg% and GSCW < 1916.5 mmHg% were optimal cut-off value to detect myocardial ischemia with an FFR ≤ 0.8. Global left ventricular myocardial work indices by echocardiography exhibited a good diagnostic value in patients with CAD and may have a good clinical significance for the screening of suspected myocardial ischemia.

BackgroundThe association between shock index (SI) and myocardial work indices has not been well characterized. This study aimed to validate the value of SI and its variants [modified shock index (MSI) and age-adjusted shock index (ASI)] for predicting myocardial work impairment in patients with ST-segment elevation myocardial infarction (STEMI).MethodsLeft ventricular two-dimensional speckle-tracking echocardiography was performed in 37 patients with STEMI and in 37 age-, sex, and cardiovascular risk factor-matched controls. Left ventricular global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency (GWE) were acquired. In males, impaired myocardial work was defined as follows: GLS >−16%, GWI <1,270 mmHg%, GCW <1,650 mmHg%, global wasted work >238 mmHg%, and GWE <90%; meanwhile, in females, it was defined as GLS >−16%, GWI <1,310 mmHg%, GCW <1,544 mmHg%, global wasted work >239 mmHg%, and GWE <91%.ResultsPatients with STEMI, as compared with controls, demonstrated significantly lower GWI (1,258.53±492.83 vs. 1,968.27±277.78 mmHg%; P<0.0001), GCW (1,596.72±566.11 vs. 2,284.62±291.01 mmHg%; P<0.0001), and GWE (86.72%±5.87% vs. 96.89%±1.45%; P<0.0001) but a significantly higher GLS (−13.57±3.66 vs. −20.23±1.18; P<0.0001) and global wasted work (191.67±90.04 vs. 80.49±29.64 mmHg%; P<0.0001). The SI, MSI, and ASI were negatively correlated with GWI (SI: r=−0.788, P<0.0001; MSI: r=−0.748, P<0.0001; ASI: r=−0.647; P<0.0001), and GCW (SI: r=−0.793, P<0.0001; MSI: r=−0.763, P<0.0001; ASI: r=−0.640, P<0.0001). In contrast, all three indices showed significant positive correlations with GLS (SI: r=0.626, P<0.0001; MSI: r=0.623, P<0.0001; ASI: r=0.506, P<0.01). The SI and MSI showed excellent ability in predicting impairment in GWI [area under the receiver operating characteristic curve (AUC) =0.878 and AUC =0.877, respectively] and GCW (AUC =0.876 and AUC =0.869, respectively), which was significantly superior to that of the ASI (AUC =0.765 and AUC =0.759, respectively; P<0.05).ConclusionsThe SI and MSI outperform ASI at predicting myocardial work impairment (GWI and GCW) in patients with STEMI. Clinically, the SI or MSI should be prioritized for early risk assessment.