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. 2023 Nov 23;24(12):1682-1689.
doi: 10.1093/ehjci/jead157.

Prognostic value of left ventricular myocardial work indices in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Hoi W Wu  1 , Federico Fortuni  1   2 , Steele C Butcher  1 , Frank van der Kley  1 , Arend de Weger  3 , Victoria Delgado  1 , J Wouter Jukema  1   4 , Jeroen J Bax  1 , Nina Ajmone Marsan  1
Affiliations

Prognostic value of left ventricular myocardial work indices in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Hoi W Wu et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Left ventricular myocardial work (LVMW) is a novel echocardiographic-based method to assess left ventricular (LV) function using pressure-strain loops taking into account LV afterload. The aim of this study was to evaluate the prognostic value of LVMW indices in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).

Methods and results: LV global work index (LV GWI), LV global constructive work (LV GCW), LV global wasted work (LV GWW), and LV global work efficiency (LV GWE) were calculated in 281 patients with severe AS [age 82, interquartile range (IQR) 78-85 years, 52% male] before the TAVR procedure. LV systolic pressure was derived non-invasively by adding the mean aortic gradient to the brachial systolic pressure to adjust for afterload and calculate LVMW indices. Overall, the average LV GWI was 1872 ± 753 mmHg%, GCW 2240 ± 797 mmHg%, GWW 200 (IQR 127-306) mmHg%, and GWE 89 (IQR 84-93)%. During a median follow-up of 52 (IQR 41-67) months, 64 patients died. While LV GWI was independently associated with all-cause mortality (Hazard ratio per-tertile-increase 0.639; 95%CI 0.463-0.883; P = 0.007), LV GCW, GWW, and GWE were not. When added to a basal model, LV GWI yielded a higher increase in predictivity compared to the left ventricular ejection fraction as well as LV global longitudinal strain and LV GCW, and also across the different haemodynamic categories (including low-flow low-gradient) of AS.

Conclusion: LV GWI is independently associated with all-cause mortality in patients undergoing TAVR and has a higher prognostic value compared to both conventional and advanced parameters of LV systolic function.

Keywords: aortic stenosis; mortality; myocardial work indices.

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Conflict of interest statement

Conflict of interest: All authors declare no conflict of interest for this contribution.

Figures

Graphical Abstract
Graphical Abstract
LV myocardial work can be calculated non-invasively in patients with severe AS (upper panel). LV GWI can stratify the prognosis of patients with severe AS undergoing transcatheter aortic valve replacement (lower left panel) and showed the highest prognostic value among conventional and advanced echocardiographic parameters of LV function and AS severity (lower right panel). AS = aortic stenosis, AV = aortic valve, GLS = global longitudinal strain, LV = left ventricle, LVEF = left ventricular ejection fraction, LV GCW = left ventricular constructive work, LV GWI = left ventricular global work index, SBP = systolic blood pressure, PG = peak gradient, SV = stroke volume.
Figure 1
Figure 1
Incremental prognostic value of LV GWI over both conventional and advanced parameters of LV systolic function. The bar charts represent the predictivity (χ2) of several multivariable Cox regression models. The basal model included sex, diabetes, haemoglobin, and renal function. In this model, one variable of LV systolic function at a time was included. LV GCW and LV GWI were analysed in tertiles. The addition of LV GWI to the basal model yielded a higher increase in predictivity compared to the models including AV mean PG, LVEF, LV GLS, SV index, or LV GCW. AV, aortic valve; PG, pressure gradient; LVEF, left ventricular ejection fraction; LV GLS, left ventricular global longitudinal strain; SV, stroke volume; LV GCW, left ventricular global constructive work; LV GWI, left ventricular global work index.
Figure 2
Figure 2
Kaplan–Meier curves estimated for cumulative event rates of all-cause mortality according to LV GWI tertiles. The Kaplan–Meier curves show that patients with the lowest GWI (bottom line) had significantly worse survival during the follow-up compared to patients with higher LV GWI (top line). LV GWI, left ventricular global work index.
See this image and copyright information in PMC

References

    1. Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O et al. Contemporary presentation and management of valvular heart disease: the EURObservational Research Programme Valvular Heart Disease II Survey. Circulation 2019;140:1156–69. - PubMed
    1. Yadgir S, Johnson CO, Aboyans V, Adebayo OM, Adedoyin RA, Afarideh M et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990–2017. Circulation 2020;141:1670–80. - PubMed
    1. Rassi AN, Pibarot P, Elmariah S. Left ventricular remodelling in aortic stenosis. Can J Cardiol 2014;30:1004–11. - PubMed
    1. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al. [2021 ESC/EACTS guidelines for the management of valvular heart disease]. G Ital Cardiol (Rome) 2022;23(5 Suppl 1):e1–e75. - PubMed
    1. Kwak S, Everett RJ, Treibel TA, Yang S, Hwang D, Ko T et al. Markers of myocardial damage predict mortality in patients with aortic stenosis. J Am Coll Cardiol 2021;78:545–58. - PubMed