How to evaluate left ventricular function with echocardiography? Myocardial work estimation: a new parameter Elena Galli, MD, PhD, FESC Service de Cardiologie CHU Pontchaillou INSERM U-1099 Rennes
Disclosure Statement of Financial Interest Nothing to disclose
Assessment of LV function Global Local
Myocardial work : a piece of history 1) The P-V allows the descriptions of all the phases of myocardial cycle “ Time varying elastance model for the LV” 2) The end ‐ systolic slope of the P ‐ V relationship, that is the E max , is a mesure of myocardial contractility 3) The PV-loop area represents the external medcahnical work, whereas the triangular area under the E max line represents the elastic potential energy (PE) stored in the LV Suga H. Am J Physiol Heart Circ Physiol 236: H498 – H505, 1979
Relationship between LV work and O2 consumption Suga et al. 1979 Suga H. Am J Physiol Heart Circ Physiol, 1979 Russel et al. EHJ 2012
Non-invasive estimation of myocardial work 12 dogs et 18 patients Raw pressure traces obtained invasively Russel et al. EHJ 2012
Echographic estimation of myocardial work Russel K et al Am J Physiol 2013 Galli E et al. Echocardiography 2018
Russel K et al EHJ 2012
Parameters obtained from PSL analysis Myocardial work index (MWI) Myocardial constructive work Myocardial wasted work Myocardial WWR CW WW Myocardial work efficiency CW (CW+WW)
Is myocardial work estimation reliable?
18 patients undergoing CRT 43 hemodynamic conditions were checked Hubert A et al. 2018
What application for myocardial work?
Myocardial work and LV dyssychrony Russel K et al Am J Physiol 2013
Normal LBBB Septum Lateral wall Septum Lateral wall CW 2160 ± 465 2084 ± 327 434 ± 202 1572 ± 451* WW 191 ± 104 170 ± 101 591 ± 350 263 ± 162* WWR 0.09 ± 0.06 0.08 ± 0.05 1.57 ± 0.97 0.18 ± 0.11* WWR Russel K et al Am J Physiol 2013
Galli E et al. EHJCVI 2018
Galli E et al. EHJCVI 2018
Galli E et al. EHJCVI 2018
Galli E et al. JASE 2018
Myocardial work and HCM Galli E et al. Echocardiography 2019
AUC 0.80 95% CI ( 0.66-0.93), p<0.0001 Se 82%, Sp 65%
Myocardial work and CAD 126 patients with NSTEMI Boe E et al. EHJCVI 2015
Boe E et al. EHJCVI 2015
Myocardial work in HT and DCM
MWI MCW MWW MWE HTA ↑ ↑ =/↑ = CMP ↓ ↓↓ ↑ ↓
Are there any referral value for myocardial work?
Manganaro R et al. EHJCVI 2018
R2=0.006, p=0.002 R2=0.04, p=0.007 Manganaro R et al. EHJCVI 2018
Conclusions (1) 1. Non-invasive estimation of myocardial work is simple and no time consuming 2. With respect to strain, MW allows to take into account the effect of afterload variations on myocardial function, overcoming one of the main limits of strain 3. Reproducibility is good
Conclusions (2) 1. Myocardial work assessment is still not validated in patients with aortic stenosis and LVOTO 2. Fair acoustic windows and confidence with the assessment of strain is mandatory 3. Up to now, the clinical application is limited because of the lack of large multicenter studies assessing the utility of myocardial work in different clinical scenarios
Thanks for the attention!
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