Myocardial work in patients with dilated cardiomyopathy and advanced stage of heart failure

Abstract Background Left ventricular myocardial work (MW) assessed by echocardiography is a new index of myocardial performance. This imaging tool incorporates afterload determination using cuff blood pressure and thus provides a more load-independent measure compared with GLS. Purpose The study aimed to find a link between MW indices at discharge and complications like cardiac rehospitalization and death two tears follow-up in patients with dilated cardiomyopathy (DCM) and advanced stage of heart failure. Methods The study included 76 patients with dilated DCM(50% of ischemic etiology), left ventricle ejection fraction (LVEF) below 40%, and NYHA class IV of heart failure (HF). All the patients underwent a complex echocardiographic evaluation according to the latest guidelines. We used an E95 machine for image acquisition and an ECHOPAC 204 for image postprocessing, using the automated functional imaging (AFI) technique. The noninvasive systolic cuff pressure measurement was performed during image acquisition. Four indices were calculated: global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). The patients were followed for two years. Results 1. 24 patients presented rehospitalization for HF decompensation (31.57%), and 23 (30.26%) patients died during follow-up. 2. The patients with ischemic etiology of DCM presented lower values of MW parameters compared with patients without coronary artery disease: GWI: 653.92 (SD 330.58) vs. 586,89 (SD 284.48), GCW 937.81 (SD 388.15) vs. 849.6 (SD 349.86), GWW 244.81 (SD 121.29) vs 203.23 (SD 97.16), GWE 74.89 (SD 9.45) vs 75.78 (SD 9.01). 3. The MW parameters in DCM patients with cardiovascular death and rehospitalization were lower compared with DCM patients without rehospitalization and cardiovascular death were GWI: 455.3 (SD 285.14) ( P = 0.0001) and 555.33 (SD 210.42) (P = 0.0002); GCW: 700.69 (SD 353.104) ( P = 0.0001) and 826.875 (SD 291.29) (P = 0.0031); GWW: 215.87 (SD 88.96) (P = 0.8771) and 248.45 (SD 108.03) (P = 0.2517); GWE: 71.39 (SD 8.77) (P = 0.0005) and 73.45 (SD 7.19)(P=0.0031). Conclusion 1. MW indices values were comparable in patients with ischemic and nonischemic DCM and advanced stage of heart failure. 2. GWI, GCW, and GWE at discharge were significantly lower in DCM patients with rehospitalization and cardiac death compared with DCM patients without complications during two years of follow-up. MW indices calculation