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Myocardial work estimation: a new parameter Elena Galli, MD, PhD, - - PowerPoint PPT Presentation
Myocardial work estimation: a new parameter Elena Galli, MD, PhD, - - PowerPoint PPT Presentation
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
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Assessment of LV function
Global Local
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Myocardial work : a piece of history
1) The P-V allows the descriptions of all the phases of myocardial cycle 2) The end‐systolic slope of the P‐V relationship, that is the Emax, is a mesure of myocardial contractility 3) The PV-loop area represents the external medcahnical work, whereas the triangular area under the Emax line represents the elastic potential energy (PE) stored in the LV
Suga H. Am J Physiol Heart Circ Physiol 236: H498–H505, 1979
“Time varying elastance model for the LV”
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Suga H. Am J Physiol Heart Circ Physiol, 1979 Relationship between LV work and O2 consumption
Russel et al. EHJ 2012 Suga et al. 1979
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Russel et al. EHJ 2012
Non-invasive estimation of myocardial work
12 dogs et 18 patients Raw pressure traces obtained invasively
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Echographic estimation of myocardial work
Russel K et al Am J Physiol 2013 Galli E et al. Echocardiography 2018
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Russel K et al EHJ 2012
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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)
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Is myocardial work estimation reliable?
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Hubert A et al. 2018
18 patients undergoing CRT 43 hemodynamic conditions were checked
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What application for myocardial work?
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Russel K et al Am J Physiol 2013
Myocardial work and LV dyssychrony
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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*
Russel K et al Am J Physiol 2013
WWR
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Galli E et al. EHJCVI 2018
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Galli E et al. EHJCVI 2018
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Galli E et al. EHJCVI 2018
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Galli E et al. JASE 2018
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Myocardial work and HCM
Galli E et al. Echocardiography 2019
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AUC 0.80 95% CI ( 0.66-0.93), p<0.0001 Se 82%, Sp 65%
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Boe E et al. EHJCVI 2015
Myocardial work and CAD
126 patients with NSTEMI
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Boe E et al. EHJCVI 2015
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Myocardial work in HT and DCM
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MWI MCW MWW MWE HTA ↑ ↑ =/↑ = CMP ↓ ↓↓ ↑ ↓
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Are there any referral value for myocardial work?
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Manganaro R et al. EHJCVI 2018
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R2=0.006, p=0.002 R2=0.04, p=0.007
Manganaro R et al. EHJCVI 2018
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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
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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
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