Abstract
Left ventricular (LV) global longitudinal strain (GLS) has established itself in the last decade as a reliable, more objective method for the evaluation of LV systolic function, able to detect subtle abnormalities in LV contraction even in the presence of preserved ejection fraction (EF). However, recent studies have demonstrated that GLS, similar to LV EF, has important load dependency. Non-invasive myocardial work (MW) quantification has emerged in the last years as an alternative tool for myocardial function assessment. This new method, incorporating measurement of strain and LV pressure, has shown to overcome GLS and LV EF limitations and provide a loading-independent evaluation of myocardial performance. The presence of a commercially available echocardiographic software for the non-invasive MW calculation has allowed the application of this new method in different settings. This review sought to provide an overview on the current knowledge of non-invasive MW estimation, showing its potential applications and possible added value in clinical practice.
Highlights
Russell et al introduced a non-invasive method for assessing regional myocardial work (MW), by the analysis of Left ventricular (LV) pressure-strain loop (PSL) [13]
LV pressure curve was derived from non-invasively acquired brachial artery cuff pressure and generated by adjusting the profile of a reference LV pressure curve according to the duration of the isovolumic and ejection phases, as defined by timing of aortic and mitral valve events by echocardiography
Compared with healthy controls and those with cardiovascular risk factors, and even more impaired in presence of HF and reduced EF (HFrEF) [24]. These findings suggest that MW impairment is the compared with healthy controls and those with cardiovascular risk factors, and even more impaired in presence of HFrEF [24]
Summary
LVEF has important limitations [1]: as a volume-derived index, it relies on geometric assumptions and is extremely load-dependent, leading to considerable loss of reproducibility [2]; it may be influenced by changes in geometry (e.g., hypertrophic or dilated LV) and does not reflect the true LV contractility; it is poorly sensitive in detecting declining ventricular function [3]. Myocardial work (MW) has emerged as an alternative tool for myocardial function assessment This new parameter derives from GLS, with the advantage to incorporate information on afterload, through interpretation of strain in relation to dynamic non-invasive LV pressure.
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