Abstract
A precise and accurate assessment of left ventricular (LV) contractility is of utmost importance in terms of prognosis in most cardiac pathologies. Given the limitations of ejection fraction (EF) and global longitudinal strain (GLS) due to their load dependency, a novel imaging tool called myocardial work (MW) has emerged as a promising method for LV performance evaluation. MW is a novel, less load-dependent method based on computation of myocardial strain–arterial blood pressure curves. This method provides a more detailed assessment of segmental and global LV function incorporating the patient’s LV pressure and is derived by brachial artery pressure utilizing an empiric reference curve adjusted to the duration of the isovolumic and ejection phases as determined by echocardiography. The clinical implications of this unique method have been expanding in the last few years, which attest to the robust additive role of MW in routine practice.
Highlights
Myocardial Work: Methodology andLeft ventricular performance has traditionally been assessed by ejection fraction (EF), which has been demonstrated to be a prognostic parameter in numerous studies [1,2,3].EF is notably subjective, with various limitations [4] and wide interobserver variability
They found no differences between the age-specific subgroups, while statistically significant difference was demonstrated between men and women; in particular, global work index (GWI) and global constructed work (GCW) were higher in females (2031 ± 247 vs. 1874 ± 232 mmHg%, p = 0.001 and 2289 ± 261 vs. 2194 ± 207 mmHg%, p = 0.04, respectively)
myocardial work (MW) indices will be lower in this subgroup of patients [21]. These results show that MW is more sensitive in detecting segmental tissue fibrosis even in the early stages and can add valuable information when measured alongside EF and global longitudinal strain (GLS)
Summary
Left ventricular performance has traditionally been assessed by ejection fraction (EF), which has been demonstrated to be a prognostic parameter in numerous studies [1,2,3]. Speckle tracking imaging with global longitudinal strain (GLS) is increasingly utilized to assess even subtle myocardial dysfunction as this is a less angleand operator-dependent method It is a novel and well-validated method for clinical utility in the assessment of cardiac diseases, it remains limited by its load dependency [5,6]. A meta-analysis of 24 studies showed that variations in afterload and blood pressure can affect the normal range of strain values [7]. Following this concept, a new echocardiographic tool called myocardial work (MW), which measures the LV pressure–strain relationship through a noninvasive method, has evolved. The aim of this review is to meticulously describe how to assess MW and all its components in a step-by-step fashion, refer to the normal reference values that have been proposed in previous published studies, and discuss the clinical implications of this method
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