scholarly journals Left ventricular global longitudinal strain is superior to ejection fraction for prognostication in ebstein anomaly

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Devara ◽  
M Iftikhar ◽  
A Goda ◽  
L Shaik ◽  
R Katta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Clinical Implications ◽  
Ebstein Anomaly ◽  
Free Survival ◽  
Lv Dysfunction ◽  
Lv Systolic Function

Abstract Background Certain factors such as left ventricular (LV) geometry and loading conditions affect the validity and reliability of LV ejection fraction (LVEF) as a true measure of LV contractility. LV global longitudinal strain (LVGLS) is less sensitive to these factors, and it has superior prognostic performance in patients with acquired heart disease. The purpose of this study was to determine the clinical implications of using LVGLS (instead of LVEF) as the measure of LV systolic function in adults with Ebstein anomaly given the inherent abnormalities of LV geometry and preload in this population. Methods Retrospective cohort study of 673 adults with Ebstein anomaly (2003–2018). We hypothesized that LVGLS had a stronger correlation with heart failure indices and transplant-free survival compared to LVEF. Results Compared to LVEF, LVGLS had stronger correlations with cardiac index (r=0.46 vs r=0.21, p=0.007), glomerular filtration rate (r=0.57 vs r=0.19, p<0.001), and NT-proBNP (r=−0.64 vs r=−0.41, p=0.01). Of 673 patients, 514 (76%) had normal LV systolic function (LVGLSNormal-LVEFNormal), 87 (13%) had subclinical LV dysfunction (LVGLSLow-LVEFNormal) and 66 (10%) had overt LV dysfunction (LVGLSLow-LVEFLow). Compared to the overt LV dysfunction group, the subclinical LV dysfunction group had similar 10-year transplant-free survival (64% vs 63%, p=0.6), but were less likely to be on heart failure therapy (12% vs 82%, p<0.001). LVGLS (but not LVEF) was the independent predictor of transplant-free survival Conclusions LVGLS provided more robust risk stratification and prognostication than LVEF in patients with Ebstein anomaly, and patients with low LVGLS had reduced transplant-free survival regardless of LVEF. The use of LVGLS (rather than LVEF) as the measure of LV systolic function has important clinical implications with regards to initiation of medical and surgical therapies. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Estimation of myocardial work – a new concept of non-invasive left ventricular systolic function assessment

2021 ◽  
Vol 28 (1) ◽  
pp. 56-65
Author(s):  
M.Yu. Kolesnyk
Keyword(s):  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Non Invasive ◽  
Lv Systolic Function

Assessment of left ventricular (LV) systolic function is a mandatory component of cardiovascular diseases diagnostics. In clinical practice, the main parameters are the ejection fraction and LV global longitudinal strain. Both parameters have a number of limitations, including dependence on afterload. This review describes a new technique for non-invasive assessment of global and segmental myocardial contractility based on the calculation of myocardial work by analyzing pressure-strain curves. The main advantage of the technique is the ability to take into account the afterload conditions by the traditional measurement of blood pressure on the brachial artery. The characteristics of the key parameters of the methodology (global work index, global constructive work, global effective and wasted work) as well as their normative values are presented. The stages of the analysis and the limitations of the method are described separately. The results of the main pilot studies of myocardial work parameters in various cardiovascular diseases are presented. Possibilities of the technique for characterizing LV segmental function in left bundle branch block, selection of patients for cardiac resynchronization therapy with subsequent response assessment are presented. The diagnostic and prognostic value of the parameters of myocardial work in arterial hypertension, acute and chronic forms of ischemic heart disease, hypertrophic and dilated cardiomyopathy, chronic heart failure are analyzed. The possibilities of the technique in assessing the effectiveness of therapy in patients with heart failure are described. Potential advantages of the parameters of myocardial work over other markers of LV systolic function, such as ejection fraction and global longitudinal strain, have been determined. The review is illustrated with clinical examples of the use of the technique for various cardiovascular diseases from our own practice.

scholarly journals Left ventricular function in rheumatoid arthritis during anti-TNF-α treatment: a speckle tracking prospective echocardiographic study

2016 ◽  
Vol 84 (1-2) ◽  
Author(s):  
Enrico Vizzardi ◽  
Ilaria Cavazzana ◽  
Franco Franceschini ◽  
Ivano Bonadei ◽  
Edoardo Sciatti ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Complications ◽  
Tnf Α ◽  
One Year

<p><strong>Aim</strong>. Rheumatoid arthritis (RA) shows a high risk for cardiovascular disease, including heart failure. Although TNF-α has been implicated in the pathogenesis of myocardial remodelling, TNF-α inhibition did not show any efficacy in patients with advanced heart failure and should be contraindicated in RA with cardiac complications. We aimed to assess global left ventricular (LV) systolic function using global longitudinal strain (GLS) as a measure of myocardial deformation, in a group of RA patients before and during anti-TNF-α treatment. <strong>Methods</strong>. 13 patients (female:male 7:6) affected by RA were prospectively followed for one year during anti TNF-α treatment. Every subject underwent echocardiography before starting anti-TNF-α drugs and after one year of treatment, to evaluate LV ejection fraction (EF), telediastolic diameter, telediastolic volume and global longitudinal strain (GLS) that was calculated using 2D speckle tracking as the mean GLS from three standard apical views (2, 3 and 4 -chambers). The patients showed a mean age of 43 years at RA onset (SD: 13) and a mean follow-up of 7.3 years (SD: 4.8). Steroid and methotrexate were used in 84.6% and 100%, respectively, in association with etanercept (6 cases), adalimumab (4 cases) and infliximab (3 cases). <strong>Results</strong>. Patients globally showed a normal EF before and after one year of treatment (mean: 65% and 65.7%, respectively). GLS did not differ before or after anti-TNF-α treatment (mean: -15.8% and -16.7%, respectively). <strong>Conclusion</strong>. Anti-TNF-α treatment did not significantly modify myocardial contractility after 12 months.</p><p> </p><p> </p>

P1812Speckle tracking echocardiography for early detection of left ventricular systolic dysfunction in patients with Chagas disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M C P Nunes ◽  
A L P Ribeiro ◽  
O R S Junior ◽  
C D L Olivera ◽  
C S Cardoso ◽  
...  
Keyword(s):  
Early Detection ◽  
Chagas Disease ◽  
Longitudinal Strain ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Lv Dysfunction

Abstract Introduction Longitudinal strain by speckle tracking echocardiography (STE) imaging is a reliable tool for quantitative measurement of myocardial contractility. Assessment of left ventricular (LV) systolic function has a central role in the evaluation of patients with Chagas disease, particularly for identification of subtle changes that could predict disease progression. Purpose We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in patients with Chagas disease and its relationship to other echocardiographic and laboratory parameters. Methods Eight-hundred and fifty patients with Chagas disease (mean age of 60±12 years, 70% female) who live in remote areas in Brazil were enrolled. Clinical evaluation, ECG, N-terminal pro-brain natriuretic peptide (NT-ProBNP), and echocardiogram were performed. LV GLS was assessed offline on the four-, three- and two-chamber views. Patients were divided into tertiles according to the LV strain. Data were analyzed using One-way ANOVA. Results The ECG was normal in 19%, whereas typical ECG abnormalities related to Chagas cardiomyopathy were found in 58% of the patients. Overall mean LV ejection fraction (LVEF) was 59±11%, and LV GLS was - 14.1±4.4%. Apical aneurysm was detected in 34 patients (4%).The prevalence of LV systolic dysfunction, defined as LVEF <54% and GLS ≤ |16|%, was 19% and 66%, respectively. Abnormal GLS was observed in 408 (48%) patients despite a normal LVEF. Stratified according to tertiles of LV GLS, patients in the first tertile (strain <|10.7|%), had a significantly decreased in LVEF (Fig 1, A), increased E/e' ratio (Fig 2,B), left atrial volume (Fig 1,C), and NT-proBNP levels (Fig 1,D), indicating severity of LV dysfunction (n=215). Similarly, the patients in the third tertile (strain >|17|%), had normal standard echo parameters and NT-proBNP levels (n=210). However, patients in the second tertile (|10.7|% to |17|%; n=425), the strain was abnormal while other parameters were normal, showing LV impairment that was not evidenced by conventional exams. Conclusions LV longitudinal strain assessed by STE in a general population of Chagas disease provided diagnostic information beyond conventionally measured LVEF. Early detection of ventricular impairment may help to identify Chagas disease patients at risk for development of heart failure.

scholarly journals Assessment of global longitudinal strain and plasma natriuretic peptide in patients with asymptomatic left ventricular dysfunction

Kardiologiia ◽  
2021 ◽  
Vol 61 (10) ◽  
pp. 53-60
Author(s):  
Ganchimeg Ulziisaikhan ◽  
Mungun-Ulzii Khurelbaatar ◽  
Chingerel Khorloo ◽  
Naranchimeg Sodovsuren ◽  
Altaisaikhan Khasag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Roc Curve ◽  
Longitudinal Strain ◽  
Troponin I ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Systolic Function

Objective    The purpose of this study was to investigate the association between global longitudinal strain (GLS) and plasma NT-proBNP for predicting left ventricular (LV) performance in asymptomatic patients after acute myocardial infarction (AMI).Material and methods    We prospectively included patients with diagnosis of AMI without clinical signs and symptoms of heart failure (HF) and followed these patients for 6 mos. Baseline echocardiography was performed at admission, and follow-up echocardiography was performed after 6 mos. A normal GLS was defined as having an absolute value of ≥16 %. According to the baseline GLS, participants were divided into two groups and compared. In all participants, blood samples of plasma NT-proBNP were obtained at admission, before discharge, and 6 mo after discharge.Results    The study population was consisted of 98 participants, of which 80 (81.6 %) were males, and the mean age was 56.0±9.3 years. Baseline echocardiography showed that most of the participants (60, 61.2 %) had abnormal GLS<16 %, whereas 38 (38.8 %) participants had normal or borderline GLS ≥16 %. Compared with the normal GLS group, participants with abnormal GLS had higher GRACE score, higher troponin I concentration, lower systolic blood pressure, lower mean LV ejection fraction, and decreased LV diastolic function. At 6‑mo follow-up, only LV systolic function remained significantly different between the two groups. Compared to baseline, there was a significant improvement of GLS in the abnormal GLS group at 6‑mo follow-up (p=0.04). Prevalence of complications after AMI was significantly higher in this group. There were significant differences between baseline and discharge NT-proBNP concentrations between the two groups (p<0.05). In the abnormal GLS group, there were significant correlations between baseline and discharge NT-proBNP concentrations with baseline LV systolic function. Discharge NT-proBNP concentration also correlated significantly with 6‑mo follow-up GLS. For determining the effect of baseline GLS abnormality, the areas under the ROC curve for baseline and discharge NT-proBNP concentrations were 0.73 (95 % CI 0.60–0.85, p=0.001) and 0.77 (95 % CI 0.66–0.87, p<0.001), respectively. Regarding early prediction of follow-up GLS abnormality, the area under the ROC curve for discharge NT-proBNP concentration was significantly higher 0.70 (95 % CI 0.55–0.84, p=0.016). The optimum cut-off value of discharge NT-pro-BNP was 688.5 pg / ml, with 72.4 % sensitivity and 65.4 % specificity to predict 6‑mon GLS abnormality following acute myocardial infarction.Conclusion    The main finding of this study is that impaired LV GLS is associated with elevated plasma concentrations of NT-proBNP in post-AMI patients. Pre-discharge NT-proBNP concentration combined with impaired initial GLS could predict worsening LV systolic function over time in asymptomatic post-AMI patients.

P3377MDCT-derived left ventricular global longitudinal strain and left ventricular ejection fraction in patients with aortic stenosis: a comparative analysis with echocardiographic measurements

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Gegenava ◽  
P Bijl ◽  
M Vollema ◽  
F Kley ◽  
A Weger ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Mean Value ◽  
Left Ventricular ◽  
Altman Analysis ◽  
Limits Of Agreement ◽  
Bland Altman Analysis ◽  
Lv Systolic Function

Abstract Introduction Known predictors of poor outcome in aortic valve stenosis patients include older age, significant valvular calcification, rapid hemodynamic progression and impaired left ventricular (LV) systolic function. LV global longitudinal strain (GLS) quantifies myocardial deformation and LV function and is associated with prognosis in patients with severe aortic stenosis (AS). Multi-detector row computed tomography (MDCT) data are key in the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI) and when acquired throughout the entire cardiac cycle, LV systolic function can be assessed. Novel software can assess LV GLS from MDCT-data. Purpose The present study aimed at assessing the feasibility of determining novel MDCT-derived LV GLS as well as MDCT-derived LV ejection fraction (EF) and their agreement with echocardiographic LV GLS and LVEF in patients treated with TAVI. Methods LVEF and LV GLS were measured on echocardiography and dynamic MDCT using novel CT-software. Agreement between the measurements of two different modalities was assessed using Bland-Altman analysis. Results A total 214 patients (51% male, mean age: 80±7 years) were analysed retrospectively. Mean value of LV GLS on echocardiography was −14±4% whereas mean MDCT-derived GLS was −12.5±4%. Mean value of LVEF on echocardiography was 47±10% and mean MDCT-derived LVEF was 39±11%. On Bland-Altman analysis, MDCT-derived strain analysis underestimated LV GLS compared to echocardiography with a mean difference of 1.44% (95% limits of agreement −3.8 to 6.7%). LVEF was also underestimated on CT with a mean difference of 7.68% (95% limits of agreement −11.5% to −26%). Correlation of measurements between MDCT-derived LV GLS and echocardiographic LV GLS was significant (r=0.791, p<0.001), as well as the correlation between MDCT-derived LVEF and echocardiographic LVEF (r=0.590, p<0.001) (Figure). Conclusions Assessment of LV GLS and LVEF on dynamic MDCT data provides similar values to those obtained with echocardiography and could be used in the risk-stratification of severe AS patients undergoing TAVI.

scholarly journals Prognostic Value of Left Ventricular Function and Mechanics in Pulmonary Hypertension: A Pilot Cardiovascular Magnetic Resonance Feature Tracking Study

Medicina ◽  
2019 ◽  
Vol 55 (3) ◽  
pp. 73 ◽  
Author(s):  
Lina Padervinskienė ◽  
Aušra Krivickienė ◽  
Deimantė Hoppenot ◽  
Skaidrius Miliauskas ◽  
Algidas Basevičius ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiovascular Magnetic Resonance ◽  
Feature Tracking ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Lv Systolic Function

Background and objective: Cardiovascular magnetic resonance (CMR) - based feature tracking (FT) can detect left ventricular (LV) strain abnormalities in pulmonary hypertension (PH) patients, but little is known about the prognostic value of LV function and mechanics in PH patients. The aim of this study was to evaluate LV systolic function by conventional CMR and LV global strains by CMR-based FT analysis in precapillary PH patients, thereby defining the prognostic value of LV function and mechanics. Methods: We prospectively enrolled 43 patients with precapillary PH (mean pulmonary artery pressure (mPAP) 55.91 ± 15.87 mmHg, pulmonary arterial wedge pressure (PAWP) ≤15 mmHg) referred to CMR for PH evaluation. Using FT software, the LV global longitudinal strain (GLS) and global circumferential strain (GCS), also right ventricular (RV) GLS were analyzed. Results: Patients were classified into two groups according to survival (survival/non-survival). LV GLS was significantly reduced in the non-survival group (−12.4% [−19.0–(−7.8)] vs. −18.4% [−22.5–(−15.5)], p = 0.009). By ROC curve analysis, LV GLS > −14.2% (CI: 3.229 to 37.301, p < 0.001) was found to be robust predictor of mortality in PH patients. Univariable analysis using the Cox model showed that severely reduced LV GLS > −14.2%, with good sensitivity (77.8%) and high specificity (93.5%) indicated an increase of the risk of death by 11-fold. LV GLS significantly correlated in PH patients with RV ESVI (r = 0.322, p = 0.035), RV EF (r = 0.444, p < 0.003). Conclusions: LV systolic function and LV global longitudinal strain measurements using CMR-FT correlates with RV dysfunction and is associated with poor clinical outcomes in precapillary PH patients.

Prognostic implications of left ventricular global longitudinal strain in patients with bicuspid aortic valve disease and preserved left ventricular ejection fraction

2019 ◽  
Vol 21 (7) ◽  
pp. 759-767 ◽  
Author(s):  
William K F Kong ◽  
E Mara Vollema ◽  
Francesca Prevedello ◽  
Rebecca Perry ◽  
Arnold C T Ng ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Increased Risk ◽  
Prognostic Implications ◽  
Lv Systolic Function

Abstract Aims In patients with bicuspid aortic valve (BAV) and preserved left ventricular (LV) ejection fraction (EF), the frequency of impaired LV global longitudinal strain (GLS) and its prognostic implications are unknown. The present study evaluated the proportion and prognostic value of impaired LV GLS in patients with BAV and preserved LVEF. Methods and results Five hundred and thirteen patients (68% men; mean age 44 ± 18 years) with BAV and preserved LVEF (&gt;50%) were divided into five groups according to the type of BAV dysfunction: (i) normal function BAV, (ii) mild aortic stenosis (AS) or aortic regurgitation (AR), (iii) ≥moderate isolated AS, (iv) ≥moderate isolated AR, and (v) ≥moderate mixed AS and AR. LV systolic dysfunction based on 2D speckle-tracking echocardiography was defined as a cut-off value of LVGLS (−13.6%). The primary outcome was aortic valve intervention or all-cause mortality. The proportion of patients with LVGLS ≤−13.6% was the highest in the normal BAV group (97%) and the lowest in the group with moderate and severe mixed AS and AR (79%). During a median follow-up of 10 years, 210 (41%) patients underwent aortic valve replacement and 17 (3%) died. Patients with preserved LV systolic function (LVGLS ≤ −13.6%) had significantly better event-free survival compared to those with impaired LV systolic function (LVGLS &gt; −13.6%). LVGLS was independently associated with increased risk of events (mainly aortic valve replacement): hazard ratio 1.09; P &lt; 0.001. Conclusion Impaired LVGLS in BAV with preserved LVEF is not infrequent and was independently associated with increased risk of events (mainly aortic valve replacement events).

Impact of baseline feature tracking multi-detector row computed tomography-derived left ventricular global longitudinal strain on left ventricular functional recovery in TAVI patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Gegenava ◽  
P Bijl ◽  
M Vollema ◽  
F Kley ◽  
A Weger ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Functional Recovery ◽  
Feature Tracking ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Systolic Function

Abstract Background Advances in left ventricular (LV) analysis with dynamic multi-detector row computed tomography (MDCT) permit measurement of LV global longitudinal strain (GLS) and have shown their impact on risk stratification of patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Purpose To evaluate the influence of baseline feature tracking (FT) MDCT- derived LV GLS on LV functional recovery in severe AS patients undergoing TAVI. Methods A total of 194 patients with severe AS (50% male, 80±7 years) with dynamic MDCT data allowing LV GLS measurement with a novel FT algorithm and having complete echocardiography evaluation at baseline, at 3–6 months and at 1 year follow-up were evaluated. FT MDCT-derived LV GLS was measured at baseline and the study population was divided according to a cut-off value of MDCT LV GLS −14% (≤−14% [more preserved LV systolic function] vs. &gt;−14% [more impaired LV systolic function]). Results Transthoracic echocardiography (TTE)-derived Left ventricular ejection fraction (LVEF) increased over time in both groups: in patients with preserved and reduced MDCT LV GLS, and reached a higher value in patients with preserved MDCT LV GLS (52±7% at baseline, 55±7% at 3–6 months, 58±7% at 1 year follow-up vs. 43±10% at baseline, 49±10% at 3–6 months, 53±11% at 1 year follow-up; p=0.016) (Figure 1). TTE-derived LV GLS also showed greater improvement for patients with preserved MDCT LV GLS (−17±3% at baseline, −18±3% at 3–6 months, −20±3% at 1 year follow-up vs. −12±3% at baseline, −15±3% at 3–6 months, −16±3% at 1 year follow-up; p=0.027) (Figure 1). Conclusions In severe AS patients treated with TAVI, LV function improves significantly at 3–6 and at 12 months' follow-up and shows superior recovery in patients with more preserved baseline MDCT LV GLS, suggesting that MDCT-derived LV GLS has an important impact on LV functional recovery after TAVI. Funding Acknowledgement Type of funding source: None

Abstract 14432: Myocardial Work in Stage I and II Hypertensive Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Akshar Jaglan ◽  
Sarah Roemer ◽  
Ana C Perez Moreno ◽  
Bijoy K Khandheria
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Deformation Analysis ◽  
Hypertensive Patients ◽  
Reduced Ejection Fraction ◽  
Work Index ◽  
Significant Difference ◽  
Global Work ◽  
Lv Systolic Function

Introduction: Myocardial work is a novel parameter that can be used in a clinic setting to assess left ventricular (LV) pressures and deformation. This study sought to distinguish patterns of global myocardial work index in hypertensive vs. non-hypertensive patients. Methods: Fifty (25 male, mean age 60±14 years) hypertensive patients and 15 (7 male, mean age 38±12 years) control patients underwent transthoracic echocardiography at rest. Hypertensive patients were divided into stage 1 (26 patients) and stage 2 (24 patients) based on the 2017 American College of Cardiology guidelines. We excluded patients with suboptimal image quality for myocardial deformation analysis, reduced ejection fraction (EF), valvular heart disease, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were estimated from LV pressure strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using a noninvasive brachial artery cuff. Results: Global longitudinal strain (GLS) and EF were preserved between the two groups with no statistically significant difference whereas there was a statistically significant difference in the GWI (p<0.01), GCW (p=0.03), GWW (p<0.01), and GWE (p=0.03) (Figure and Table). Conclusions: Myocardial work gives us a closer look at the relationship between LV pressure and contractility in settings of increased load dependency whereas LVEF and GLS cannot. We show how myocardial work is an advanced assessment of LV systolic function in hypertensive patients.

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