Dynamics of Left Ventricular Myocardial Work in Patients Hospitalized for Acute Heart Failure.

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J Card Fail. 2021 Dec;27(12):1393-1403. doi: 10.1016/j.cardfail.2021.07.004. Epub 2021 Jul 29.

Dynamics of Left Ventricular Myocardial Work in Patients Hospitalized for Acute Heart Failure.

Journal of cardiac failure

Floran Sahiti, Caroline Morbach, Carsten Henneges, Ulrich Stefenelli, Nina Scholz, Vladimir Cejka, Judith Albert, Peter U Heuschmann, Georg Ertl, Stefan Frantz, Christiane E Angermann, Stefan Störk

Affiliations

Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany.
Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany.
Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany.
Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany. Electronic address: [email protected].

PMID: 34332057 DOI: 10.1016/j.cardfail.2021.07.004

Abstract

BACKGROUND: The left ventricular ejection fraction (LVEF) is the most commonly used measure describing pumping efficiency, but it is heavily dependent on loading conditions and therefore not well-suited to study pathophysiologic changes. The novel concept of echocardiography-derived myocardial work (MyW) overcomes this disadvantage as it is based on LV pressure-strain loops. We tracked the in-hospital changes of indices of MyW in patients admitted for acute heart failure (AHF) in relation to their recompensation status and explored the prognostic utility of MyW indices METHODS AND RESULTS: We studied 126 patients admitted for AHF (mean 73 ± 12 years, 37% female, 40% with a reduced LVEF [<40%]), providing pairs of echocardiograms obtained both on hospital admission and prior to discharge. The following MyW indices were derived: global constructive and wasted work (GCW, GWW), global work index (GWI), and global work efficiency. In patients with HF with reduced ejection fraction with decreasing N-terminal prohormone B-natriuretic peptide levels during hospitalization, the GCW and GWI improved significantly, whereas the GWW remained unchanged. In patients with HF with preserved ejection fraction, the GCW and GWI were unchanged; however, in patients with no decrease or eventual increase in N-terminal prohormone B-natriuretic peptide, we observed an increase in GWW. In all patients with AHF, higher values of GWW were associated with a higher risk of death or rehospitalization within 6 months after discharge (per 10-point increment hazard ratio 1.035, 95% confidence interval 1.005-1.065).

CONCLUSIONS: Our results suggest differential myocardial responses to decompensation and recompensation, depending on the HF phenotype in patients presenting with AHF. The GWW predicted the 6-month prognosis in these patients, regardless of LVEF. Future studies in larger cohorts need to confirm our results and identify determinants of short-term and longer term changes in MyW.

Keywords: Acute heart failure; echocardiography; myocardial work; recompensation

Conflict of interest statement

Declaration of Competing Interest Floran Sahiti receives financial support from IZKF Würzburg (MD/PhD program scholarship). Caroline Morbach reports a research cooperation with the University of Würzb

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Journal Article