Association between left ventricular geometry and global myocardial work in patients with heart failure with preserved ejection fraction: assessment using strain-pressure loop

Background and Aims: Concentric LV remodeling and hypertrophy are common structural abnormalities in patients with heart failure with preserved ejection fraction (HFpEF) and tend to be accompanied by impaired LV function. Assessment of global myocardial work (GMW) using strain-pressure loop may provide more comprehensive assessment of LV myocardial function, overcoming the limitations of the conventional parameters. We investigated the value of GMW in patients with HFpEF and assessed the relationship of GMW with concentric remodeling and hypertrophy. Methods: : Consecutive patients with HFpEF (n=107) and sex-matched healthy controls (n=32) were prospectively enrolled. Clinical and conventional echocardiography variables were obtained. Further analyses of offline data were performed to obtain GMW indices including global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE). Association of concentric remodeling and hypertrophy with GMW was analyzed by univariate and multivariate analysis. Results: : HFpEF patients showed lower GWE (94% vs 96%, P <0.001) and higher GWW (136 mmHg% vs 87 mmHg%, P =0.003) than control group, while GWI (2111 mmHg% vs 2146 mmHg%, P =0.877) and GCW (2369 mmHg% vs 2469 mmHg%, P =0.733) were comparable in the two groups. HFpEF patients with relative wall thickness (RWT) >0.42 had reduced GWE (93% vs 94%, P =0.015) compared to HFpEF patients with RWT≤0.42, while GWI, GCW, and GWW were comparable between these two subgroups. Multivariate analysis showed an independent association of RWT with GWI, GCW, and GWE, respectively. Conclusion: Impaired global myocardial work was detected in patients with HFpEF. Impaired LV GMW may be associated with increased RWT.