Objectives: The aim of this study was to investigate whether echocardiographic
assessment of myocardial work is a predictor of outcome in advanced heart failure.
Background: Global work index (GWI) and global constructive work (GCW) are
calculated bymeans of speckle tracking, blood pressuremeasurement, and a normalized
reference curve. Their prognostic value in advanced heart failure is unknown.
Methods: Cardiopulmonary exercise testing and echocardiography with assessment
of GWI and GCW was performed in patients with advanced heart failure caused by
ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up
repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular
assist device, or heart transplantation.
Results: The median patient age was 54 years (interquartile range [IQR]: 48–59.9). The
mean left ventricular ejection fraction was 27.8 ± 8.2%, the median NT-proBNP was
1,210 pg/ml (IQR: 435–3,696). The mean GWI was 603 ± 329 mmHg% and the mean
GCW was 742 ± 363 mmHg%. The correlation between peak oxygen uptake and GWI
as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p
= 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months
(IQR: 12–18.5). Thirty one patients met the combined endpoint: Four patients died, eight
underwent transplantation, and 19 underwent implantation of a left ventricular assist
device. In themultivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI
(hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77–0.94; p = 0.002) as well as
GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79–0.94; p = 0.001) were identified as
independent predictors of the endpoint. The cut-off value for predicting the outcome was
455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and
530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%).
Conclusions: GWI and GCW are powerful predictors of outcome in patients with
advanced heart failure.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:84545 |
| Date | 04 April 2023 |
| Creators | Hedwig, Felix, Nemchyna, Olena, Stein, Julia, Knosalla, Christoph, Merke, Nicolas, Knebel, Fabian, Hagendorff, Andreas, Schoenrath, Felix, Falk, Volkmar, Knierim, Jan |
| Publisher | Frontiers Research Foundation |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 2297-055X, 691611 |
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