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. 2020 Oct 8;15(10):e0239684.
doi: 10.1371/journal.pone.0239684. eCollection 2020.

Myocardial work - correlation patterns and reference values from the population-based STAAB cohort study

Caroline Morbach  1   2 , Floran Sahiti  1   2 , Theresa Tiffe  1   3 , Vladimir Cejka  1 , Felizitas A Eichner  1   3 , Götz Gelbrich  1   3   4 , Peter U Heuschmann  1   3   4 , Stefan Störk  1   2 ; STAAB consortium
Affiliations

Myocardial work - correlation patterns and reference values from the population-based STAAB cohort study

Caroline Morbach et al. PLoS One. .

Abstract

Background: Recently, myocardial work analysis as an echocardiographic tool to non-invasively determine LV work has been introduced and validated against invasive measurements. Based on systolic blood pressure and speckle-tracking derived longitudinal strain (GLS) during systole and isovolumic relaxation, it is considered less load-dependent than LV ejection fraction (LVEF) or GLS and to integrate information on LV active systolic and diastolic work.

Objectives: We aimed to establish reference values for global constructive (GCW) and global wasted work (GWW) as well as of global work index (GWI) and global work efficiency (GWE) across a wide age range and to assess the association with standard echocardiography parameters to estimate the potential additional information provided by myocardial work (MyW).

Methods: The Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study carefully characterized a representative sample of the population of the City of Würzburg, Germany, aged 30-79 years. We performed myocardial work analysis using the standardized, quality-controlled transthoracic echocardiograms of all individuals lacking any cardiovascular risk factor.

Results: Out of 4965 participants, 779 (49±10 years, 59% women) were eligible for the present analysis. Levels of GCW, GWW, and GWE were independent of sex and body mass index, and were stable until the age of 45 years. Thereafter, we observed an upward shift to further stable values of GCW and a linear increase of GWW with advancing age, resulting in lower GWE. Age-adjusted percentiles for GCW, GWW, GWI, and GWE were derived. Higher levels of blood pressure or LV mass were associated with higher GCW, GWI, and GWW, resulting in lower GWE; higher LVEF correlated with higher GCW and GWI, but lower GWW. Higher E/e´ correlated with higher GWW, higher e´ with lower GWW.

Conclusions: Derived from a large sample of apparently healthy individuals from a population based-cohort, we provide age-adjusted reference values for myocardial work indices, applicable for either sex. Weak correlations with common echocardiographic parameters suggest MyW indices to potentially provide additional information, which has to be evaluated in diseased patient cohorts.

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Conflict of interest statement

Caroline Morbach reports a research cooperation with the University of Würzburg and Tomtec Imaging Systems funded by a research grant from the Bavarian Ministry of Economic Affairs, Regional Development and Energy, Germany, speakers honorarium from Amgen, Alnylam and Tomtec, a travel grant from Orion Pharma and Alnylam, and participation in Advisory and Patient Eligibility Boards sponsored by AKCEA, Alnylam, Pfizer and EBR Systems outside the submitted work. Floran Sahiti has nothing to disclose Theresa Tiffe has nothing to disclose. Vladimir Cejka has nothing to disclose. Felizitas Eichner has nothing to disclose Götz Gelbrich reports a research cooperation with the University Hospital Würzburg and TomTec Imaging Systems funded by a research grant from the Bavarian Ministry of Economic Affairs, Regional Development and Energy, Germany, and a grant from the German Research Council (DFG) as the senior biometrician of the FIND-AF II trial outside the submitted work. Peter Heuschmann reports grants from German Ministry of Research and Education, European Union, Charité – Universitätsmedizin Berlin, Berlin Chamber of Physicians, German Parkinson Society, University Hospital Würzburg, Robert Koch Institute, German Heart Foundation, Federal Joint Committee (G-BA) within the Innovationfond, University Hospital Heidelberg (within RASUNOA-prime; RASUNOA-prime is supported by an unrestricted research grant to the University Hospital Heidelberg from Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo), grants from Charité – Universitätsmedizin Berlin (within Mondafis; Mondafis is supported by an unrestricted research grant to the Charité from Bayer), from University Göttingen (within FIND-AF randomized; FIND-AF randomized is supported by an unrestricted research grant to the University Göttingen from Boehringer-Ingelheim), outside the submitted work. Stefan Störk reports research grants from the German Ministry of Education and Research, European Union, University Hospital Würzburg; participation in Data Safety Monitoring or Event Adjudication in studies sponsored by Roche, Medtronic; participation in Advisory Boards for Novartis, Bayer, Boehringer Ingelheim, Thermo-Fisher, Boston Scientific; principal investigator in trials (co-) sponsored by Boehringer-Ingelheim, Novartis, Bayer, Lundbeck; speaker honoraria by Boehringer-Ingelheim, Servier, Novartis, Astra-Zeneca, Pfizer, Bayer, Thermo-Fisher, outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Determination of myocardial work.
For exact timing, mitral valve opening and closure are determined using a pulsed-wave Doppler recording of the mitral inflow (A). Aortic valve opening and closure are determined using a continuous-wave Doppler recording through the aortic valve (B). Time points might be adjusted in the apical three chamber view (D), if necessary. Using automated function imaging, global longitudinal strain is determined in the apical three (C), four (D), and two (E) chamber views. The automated speckle tracking contour can be adjusted manually. After completion of strain determination (F), systolic and diastolic blood pressure levels have to entered (G) in order to determine global and segmental myocardial work (H).
Fig 2
Fig 2. Study flow.
Fig 3
Fig 3. Association of global constructive (GCW, A) and global wasted (GWW, B) myocardial work with age and distribution of GCW (C) and GWW values (D).
The curves were obtained from locally weighted regression analysis.
See this image and copyright information in PMC

References

    1. Voorhees A.P. and Han H.C., Biomechanics of Cardiac Function. Compr Physiol, 2015. 5(4): p. 1623–44. 10.1002/cphy.c140070 - DOI - PMC - PubMed
    1. Russell K., et al., A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work. Eur Heart J, 2012. 33(6): p. 724–33. 10.1093/eurheartj/ehs016 - DOI - PMC - PubMed
    1. Russell K., et al., Assessment of wasted myocardial work: a novel method to quantify energy loss due to uncoordinated left ventricular contractions. Am J Physiol Heart Circ Physiol, 2013. 305(7): p. H996–1003. 10.1152/ajpheart.00191.2013 - DOI - PubMed
    1. Hubert A., et al., Estimation of myocardial work from pressure-strain loops analysis: an experimental evaluation. Eur Heart J Cardiovasc Imaging, 2018. 19(12): p. 1372–1379. 10.1093/ehjci/jey024 - DOI - PubMed
    1. Manganaro R., et al., Echocardiographic reference ranges for normal non-invasive myocardial work indices: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging, 2019. 20(5): p. 582–590. 10.1093/ehjci/jey188 - DOI - PubMed

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