scholarly journals Myocardial Work by Echocardiography: Principles and Applications in Clinical Practice

2021 ◽  
Vol 10 (19) ◽  
pp. 4521
Author(s):  
Federica Ilardi ◽  
Antonello D’Andrea ◽  
Flavio D’Ascenzi ◽  
Francesco Bandera ◽  
Giovanni Benfari ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Current Knowledge ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
New Method ◽  
Added Value ◽  
Non Invasive ◽  
Potential Applications ◽  
Lv Systolic Function

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.

scholarly journals Non-Invasive Assessment of Left Ventricle Ejection Fraction: Where Do We Stand?

2021 ◽  
Vol 11 (11) ◽  
pp. 1153
Author(s):  
Alessandra Scatteia ◽  
Angelo Silverio ◽  
Roberto Padalino ◽  
Francesco De Stefano ◽  
Raffaella America ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Ejection Fraction ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricle Ejection Fraction ◽  
Advantages And Disadvantages ◽  
Non Invasive ◽  
Lv Ejection Fraction ◽  
Lv Systolic Function ◽  
Invasive Evaluation

The left ventricular (LV) ejection fraction (EF) is the preferred parameter applied for the non-invasive evaluation of LV systolic function in clinical practice. It has a well-recognized and extensive role in the clinical management of numerous cardiac conditions. Many imaging modalities are currently available for the non-invasive assessment of LVEF. The aim of this review is to describe their relative advantages and disadvantages, proposing a hierarchical application of the different imaging tests available for LVEF evaluation based on the level of accuracy/reproducibility clinically required.

scholarly journals Assessment of left ventricular systolic function by non-invasive pressure-strain loop area in young male strength athletes

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Pengge Li ◽  
Yonggao Zhang ◽  
Lijin Li ◽  
Yingchun Chen ◽  
Zhen Li ◽  
...  
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Young Male ◽  
Left Ventricular ◽  
Control Group ◽  
Peak Strain ◽  
Non Invasive ◽  
Lv Systolic Function ◽  
Contractile Performance ◽  
Athlete Group

Abstract Background The health of athletes has been recognized as a worldwide public concern with more reported sudden cardiac deaths (SCD). Therefore, early detection of abnormal heart function in athletes can help reduce the risk of exercise. A novel valid non-invasive method to evaluate left ventricular (LV) myocardial work (MW) using LV pressure-strain loop (PSL), was used in this paper to explore LV systolic function in young male strength athletes. Methods Thirty-six professional young male strength athletes (the athlete group) and 32 healthy, age-matched young men (the control group) were involved in the study. The LVMW parameters were calculated as the area of PSL by two-dimensional speckle tracking echocardiography (2D-STE) and peak systolic LV pressure. The differences between two groups of data and the predictive efficacy of MW parameters for LV systolic function were analyzed. Results The athlete group had significantly higher values of global wasted myocardial work (GWW) and peak strain dispersion (PSD) than did the control group (P<0.05). Global myocardial work index (GWI), global constructive myocardial work (GCW) and global longitudinal strain (GLS) were lower in the athlete group than that in the control group, although statistical significance was not reached (P>0.05). Due to the proportion of GWW and GCW, statistically significant reduction was found in global myocardial work efficiency (GWE) in the athlete group. Conventional echocardiography parameters were well correlated with GWW and GWE (P<0.05). The best predictor of LV myocardial contractile performance in the athletes using receiver operating characteristic curve (ROC) was GWE, with the area under ROC (AUC) of 0.733, sensitivity of 83.3% and specificity of 59.4%. Conclusions Subclinical changes have appeared in the hearts of young male strength athletes after long-term intensive exercise and LVMW parameters by PSL play an important role in the evaluation of athlete’s LV contractile performance.

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 Assessment of left ventricular systolic function by non-invasive pressure-strain loop area in young male strength athletes

2020 ◽  
Author(s):  
Shaohua Hua ◽  
Pengge Li ◽  
Lijin Li ◽  
Yingchun Chen ◽  
Zhen Li ◽  
...  
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Young Male ◽  
Left Ventricular ◽  
Control Group ◽  
Peak Strain ◽  
Non Invasive ◽  
Lv Systolic Function ◽  
Contractile Performance ◽  
Athlete Group

Abstract Background The health of athletes has been recognized as a worldwide public concern with more reported sudden cardiac deaths (SCD). Therefore, early detection of abnormal heart function in athletes can help reduce the risk of exercise. A novel valid non-invasive method to evaluate left ventricular (LV) myocardial work (MW) using LV pressure-strain loop (PSL), was used in this paper to explore LV systolic function in young male strength athletes. Methods 36 professional young male strength athletes (the athlete group) and 32 healthy, age-matched young men (the control group) were involved in the study. The LVMW parameters were calculated as the area of PSL by two-dimensional speckle tracking echocardiography (2D-STE) and peak systolic LV pressure. The differences between two groups of data and the predictive efficacy of MW parameters for LV systolic function were analyzed. Results The athlete group had significantly higher values of global wasted myocardial work (GWW) and peak strain dispersion (PSD) than did the control group (P༜0.05).Global myocardial work index (GWI), global constructive myocardial work (GCW) and global longitudinal strain (GLS) were lower in the athlete group than that in the control group, although statistical significance was not reached (P༞0.05). Due to the proportion of GWW and GCW, statistically significant reduction was found in global myocardial work efficiency (GWE) in the athlete group. The best predictor of LV myocardial contractile performance in the athletes using receiver operating characteristic curve (ROC) was GWE, with the area under ROC (AUC) of 0.733, sensitivity of 83.3% and specificity of 59.4%. Conclusions Subclinical changes have appeared in the hearts of young male strength athletes after long-term intensive exercise and LVMW parameters by PSL play an important role in the evaluation of athlete’s LV contractile performance.

scholarly journals Assessment of left ventricular systolic function by non-invasive pressure-strain loop area in young male strength athletes

2020 ◽  
Author(s):  
Shaohua Hua ◽  
Pengge Li ◽  
Yonggao Zhang ◽  
Lijin Li ◽  
Yingchun Chen ◽  
...  
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Young Male ◽  
Left Ventricular ◽  
Control Group ◽  
Peak Strain ◽  
Non Invasive ◽  
Lv Systolic Function ◽  
Contractile Performance ◽  
Athlete Group

Abstract BackgroundThe health of athletes has been recognized as a worldwide public concern with more reported sudden cardiac deaths (SCD). Therefore, early detection of abnormal heart function in athletes can help reduce the risk of exercise. A novel valid non-invasive method to evaluate left ventricular (LV) myocardial work (MW) using LV pressure-strain loop (PSL), was used in this paper to explore LV systolic function in young male strength athletes.Methods 36 professional young male strength athletes (the athlete group) and 32 healthy, age-matched young men (the control group) were involved in the study. The LVMW parameters were calculated as the area of PSL by two-dimensional speckle tracking echocardiography (2D-STE) and peak systolic LV pressure. The differences between two groups of data and the predictive efficacy of MW parameters for LV systolic function were analyzed.Results The athlete group had significantly higher values of global wasted myocardial work (GWW) and peak strain dispersion (PSD) than did the control group (P＜0.05).Global myocardial work index (GWI), global constructive myocardial work (GCW) and global longitudinal strain (GLS) were lower in the athlete group than that in the control group, although statistical significance was not reached (P＞0.05). Due to the proportion of GWW and GCW, statistically significant reduction was found in global myocardial work efficiency (GWE) in the athlete group. Conventional echocardiography parameters were well correlated with GWW and GWE (P＜0.05). The best predictor of LV myocardial contractile performance in the athletes using receiver operating characteristic curve (ROC) was GWE, with the area under ROC (AUC) of 0.733, sensitivity of 83.3% and specificity of 59.4%. ConclusionsSubclinical changes have appeared in the hearts of young male strength athletes after long-term intensive exercise and LVMW parameters by PSL play an important role in the evaluation of athlete’s LV contractile performance.

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.

scholarly journals Evaluation of left ventricular myocardial work quantitatively by pressure-strain loop in young strength athletes with different heart rates

2021 ◽  
Author(s):  
Pengge Li ◽  
Yonggao Zhang ◽  
Lijin Li ◽  
Mengjiao Sun ◽  
Zhen Li ◽  
...  
Keyword(s):  
Systolic Function ◽  
Linear Regression Analysis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Control Group ◽  
Peak Strain ◽  
Work Efficiency ◽  
Heart Rates ◽  
Work Index ◽  
Lv Systolic Function

Objective: The present study aimed to investigate the difference in left ventricular (LV) global and regional myocardial (MW) of strength athletes with different heart rates (HR) through non-invasive LV pressure-strain loop (PSL) and further address the effect of athlete’s heart rate variability on the LV systolic function. Methods: Fifty young professional wrestlers were collected randomly and divided into two groups in accordance with their different HR: the low HR (45~60 bpm, n=25) and the high HR (60~80 bpm, n=25). Thirty individuals with gender- and age-matched healthy volunteers served as controls ( n=30). Global and regional MW parameters were evaluated using LV-PSL derived from speckle tracking echocardiography (STE) and brachial artery pressure, and then compared between the above three groups. Results: The indicators of global and regional MW did statistically significantly differ between the athlete and control groups. Peak strain dispersion (PSD) and global myocardial wasted work (GWW) increased while global myocardial work efficiency (GWE) reduced in LHR and HHR groups compared with the control group, and global myocardial work index (GWI), global myocardial constructive work (GCW), global longitudinal strain (GLS) decreased in LHR group ( P＜0.05). In comparison to the LHR group, GWI, GCW, GWW, PSD increased in HHR group and GWE reduced ( P＜0.05). According to the regional MW analysis, the mean regional myocardial work index (RMWI) increasing gradually from basal to apical levels were similar across the three groups and regional myocardial work efficiency (RMWE) did not. Multiple linear regression analysis indicated that the HR, posterior wall thickness (PWT), interventricular septal thickness (IVST), GLS, and PSD were correlated with GWE ( b’= -0.247, -0.390, -0.370, 0.340, and -0.554, respectively, P＜0.05). Conclusions: The LV contractile performance was more impaired in young strength athletes with high heart rates and PSL can be used to assess LV GMW and RMW quantitatively and accurately in reflecting LV systolic function.

scholarly journals Quantitative assessment of left ventricular longitudinal function and myocardial deformation in Duchenne muscular dystrophy patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Roman Panovský ◽  
Martin Pešl ◽  
Jan Máchal ◽  
Tomáš Holeček ◽  
Věra Feitová ◽  
...  
Keyword(s):  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Cardiac Involvement ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Radial Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Muscle Impairment ◽  
Lv Systolic Function

Abstract Background Duchenne muscular dystrophy (DMD) manifests in males mainly by skeletal muscle impairment, but also by cardiac dysfunction. The assessment of the early phases of cardiac involvement using echocardiography is often very difficult to perform in these patients. The aim of the study was to use cardiac magnetic resonance (CMR) strain analysis and mitral annular plane systolic excursion (MAPSE) in the detection of early left ventricular (LV) dysfunction in DMD patients. Methods and results In total, 51 male DMD patients and 18 matched controls were examined by CMR. MAPSE measurement and functional analysis using feature tracking (FT) were performed. Three groups of patients were evaluated: A/ patients with LGE and LV EF < 50% (n = 8), B/ patients with LGE and LVEF ≥ 50% (n = 13), and C/ patients without LGE and LVEF ≥ 50% (n = 30). MAPSE and global LV strains of the 3 DMD groups were compared to controls (n = 18). Groups A and B had significantly reduced values of MAPSE, global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) in comparison to controls (p < 0.05). The values of MAPSE (11.6 ± 1.9 v 13.7 ± 2.7 mm) and GCS (− 26.2 ± 4.2 v − 30.0 ± 5.1%) were significantly reduced in group C compared to the controls (p < 0.05). Conclusion DMD patients had decreased LV systolic function measured by MAPSE and global LV strain even in the case of normal LV EF and the absence of LGE. FT and MAPSE measurement provide sensitive assessment of early cardiac involvement in DMD patients.

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.

scholarly journals Evaluation of Left Ventricular Global and Regional Myocardial Work Quantitatively by Pressure-strain Loop in Young Strength Athletes With Different Heart Rates

2021 ◽  
Author(s):  
Pengge Li ◽  
Yonggao Zhang ◽  
Lijin Li ◽  
Mengjiao Sun ◽  
Zhen Li ◽  
...  
Keyword(s):  
Systolic Function ◽  
Linear Regression Analysis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Control Group ◽  
Peak Strain ◽  
Work Efficiency ◽  
Heart Rates ◽  
Work Index ◽  
Lv Systolic Function

Abstract Objective: The present study aimed to investigate the difference in left ventricular (LV) global and regional myocardial work (MW) of strength athletes with different heart rates (HR) through non-invasive LV pressure-strain loop (PSL) and further address the effect of athlete’s resting heart rate variability on the LV systolic function.Methods:Fifty young professional wrestlers were collected randomly and divided into two groups in accordance with their different heart rates: the low HR group (45~60 bpm, n1=25) and the high HR group (60~80 bpm, n2=25). Thirty individuals with gender- and age-matched healthy volunteers served as controls (n3=30). Global and regional MW parameters were evaluated using LV-PSL derived from speckle tracking echocardiography (STE) and brachial artery pressure. The differences between three groups of data and the linear relationship among conventional echocardiographic parameters and global myocardial work efficiency (GWE) were analyzed.Results:The indicators of global and regional MW did statistically significantly differ between the athlete and control groups. Compared with the control group, Peak strain dispersion (PSD) and global myocardial wasted work (GWW) increased while GWE reduced all in the low HR and high HR groups, and global myocardial work index (GWI), global myocardial constructive work (GCW), global longitudinal strain (GLS) decreased in the low HR group (all P＜0.05). In comparison to the low HR group, GWI, GCW, GWW, PSD increased in the high HR group and GWE reduced (P＜0.05). According to the regional MW analysis, the mean regional myocardial work index (RMWI) was increased gradually from basal to apical levels, which were similar across the three groups, but regional myocardial work efficiency (RMWE) did not. Multiple linear regression analysis indicated that the HR, posterior wall thickness (PWT), interventricular septal thickness (IVST), GLS, and PSD were well correlated with GWE (b’= -0.247, -0.390, -0.370, 0.340, and -0.554, respectively, P＜0.05).Conclusions:The sub-clinical changes of LV contractile performance were more obvious in young strength athletes with high resting heart rates and PSL could be used to assess LV GMW and RMW quantitatively and accurately in reflecting LV systolic function.

Sign in / Sign up

Export Citation Format

Share Document