Myocardial work is calculated from non-invasive left
ventricular pressure and strain by speckle tracking echocardiography.
Myocardial work provides diagnostic information beyond what is achieved from
left ventricular ejection fraction and strain since it incorporates afterload,
and provides a measure of myocardial efficiency. The method can be used to
calculate global as well as segmental work. The work method was recently shown
to be of clinical value in selection of patients for cardiac resynchronization therapy.
Several other clinical applications are currently tested.
Application of the work method
should be explored in cancer patients as a means to diagnose therapy-related
cardiac dysfunction or in patients with heart failure with preserved EF to
demonstrate LV systolic dysfunction. Assessment of non-invasive myocardial work (MW) is obviously interesting
in the field of ischaemic heart disease, hypertrophic or dilated
cardiomyopathies for quantifying LV dyssynchrony and predicting outcome.
Finally, MW analysis should
not be used in hypertrophic obstructive cardiomyopathy, since the
intraventricular pressure gradient invalidates brachial artery pressure as
estimate of peak LV pressure. For aortic stenosis, the mean aortic pressure gradient
may be added to the brachial pressure. It remains to be studied if calculation
of MW may play a role in aortic stenosis and if decrease in work may be a sign
of LV decompensation.
How to measure left ventricular myocardial work bypressure–strain loops
Eur Heart J Cardiovasc Imaging. 2021 Feb
Smiseth, Erwan Donal, Martin Penicka, Ole Jakob Sletten