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. 2022 Mar 11;11(6):1555.
doi: 10.3390/jcm11061555.

Prognostic Value of Non-Invasive Global Myocardial Work in Asymptomatic Aortic Stenosis

Federica Ilardi  1   2 , Adriana Postolache  1 , Raluca Dulgheru  1 , Mai-Linh Nguyen Trung  1 , Nils de Marneffe  1 , Tadafumi Sugimoto  1   3 , Yun Yun Go  1   4 , Cécile Oury  1 , Giovanni Esposito  2 , Patrizio Lancellotti  1   5
Affiliations

Prognostic Value of Non-Invasive Global Myocardial Work in Asymptomatic Aortic Stenosis

Federica Ilardi et al. J Clin Med. .

Abstract

This study aimed to evaluate the modification of non-invasive myocardial work (MW) indices related to aortic stenosis (AS) stages of cardiac damage and their prognostic value. The echocardiographic and outcome data of 170 patients, with asymptomatic moderate-to-severe AS and left ventricular ejection fraction (LVEF) ≥ 50%, and 50 age- and sex-comparable healthy controls were analysed. Primary endpoints were the occurrence of all-cause and cardiovascular death. Increased values of the global work index (GWI), global constructive work (GCW), and global wasted work (GWW) were observed in AS patients compared to controls (GWI: 2528 ± 521 vs. 2005 ± 302 mmHg%, GCW: 2948 ± 598 vs. 2360 ± 353 mmHg%, p < 0.001; GWW: 139 ± 90 vs. 90 ± 49 mmHg%, p = 0.005), with no changes in the global work efficiency. When patients were stratified according to the stages of cardiac damage, the GWI showed lower values in Stage 3−4 as compared to Stage 0 and Stage 2 (p = 0.024). During a mean follow-up of 30 months, 27 patients died. In multivariable Cox-regression analysis, adjusted for confounders, GWI (HR: 0.998, CI: 0.997−1.000; p = 0.034) and GCW (HR:0.998, CI: 0.997−0.999; p = 0.003) were significantly associated with excess mortality. When used as categorical variables, a GWI ≤ 1951 mmHg% and a GCW ≤ 2475 mmHg% accurately predicted all-cause and cardiovascular death at 4-year follow-up. In conclusion, in asymptomatic patients with moderate-to-severe AS, reduced values of GWI and GCW are associated with increased mortality. Therefore, the evaluation of MW indices may allow for a better identification of asymptomatic patients with moderate to severe AS and preserved LVEF whom are at increased risk of worse prognosis during follow-up.

Keywords: aortic stenosis; asymptomatic; cardiac damage; myocardial work; prognosis; staging.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pressure-strain loops (left panels) and 17-segment bull’s-eye representation of GWI (right panels) in a healthy subject (A,B) and in two patients with severe aortic stenosis (C–F). Compared to the control patient, aortic stenosis patient in stage 2 of cardiac damage (C,D) presented a larger pressure–strain loop, from which higher value of GWI has been estimated. Conversely, in advanced stage of aortic stenosis (E,F), GWI reduction reflected a more impaired LV contractile performance.
Figure 2
Figure 2
Receiver operator characteristics (ROC) curve analysis for GWI (A) and GCW (B) as a predictor of all-cause death.
Figure 3
Figure 3
Forest plot showing the HR (bold square) and 95% CI for each variable in the final Cox multivariate model. Lower GCW (A) and GWI (B) values are associated with significantly higher risks of all-cause mortality.
Figure 4
Figure 4
Kaplan–Meier estimates for all cause of death (A) and cardiovascular death (B) during follow-up in asymptomatic AS patients divided in two groups according to baseline more impaired GWI (≤1951 mmHg%, blue line) vs. more preserved GWI (>1951 mmHg%, red line).
Figure 5
Figure 5
Kaplan–Meier curves of all cause (A) and cardiovascular death (B) during follow-up for asymptomatic AS patients according to baseline more impaired GCW (≤2475 mmHg%, blue line) vs. more preserved GCW (>2475 mmHg%, red line).
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