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Association Between Echocardiographic Non-invasive Myocardial Work Indices and Myocardial Fibrosis in Patients With

Cunying Cui1, Yanan Li1, Yuanyuan Liu1

  • 1Department of Ultrasound, The People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China.

Frontiers in Cardiovascular Medicine
|September 6, 2021
PubMed

Insights

Global myocardial work indices, including global constructive work (GCW), can non-invasively predict left ventricular (LV) myocardial fibrosis in dilated cardiomyopathy (DCM) patients. GCW and LV ejection fraction (LVEF) showed superior accuracy compared to global longitudinal strain (GLS).

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Biomedical Engineering

Background:

  • Dilated cardiomyopathy (DCM) is characterized by left ventricular (LV) dysfunction.
  • LV myocardial fibrosis is a key pathological feature in DCM, impacting prognosis.
  • Non-invasive assessment of myocardial fibrosis and work indices is crucial for DCM management.

Purpose of the Study:

  • To investigate the association between non-invasive global myocardial work indices and LV myocardial fibrosis in DCM patients.
  • To compare the predictive accuracy of different myocardial work indices and global longitudinal strain (GLS) for detecting LV myocardial fibrosis.

Main Methods:

  • Prospective study of 57 DCM patients.
  • Left ventricular (LV) pressure-strain loop (PSL) analysis to measure global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE).
  • Cardiac magnetic resonance imaging (CMRI) for LV volumes, LV ejection fraction (LVEFCMRI), and late gadolinium enhancement (LGE) to assess myocardial fibrosis.

Main Results:

  • Patients with LGE (fibrosis) showed significantly reduced GWI, GCW, GWE, GLS, and LVEFCMRI compared to those without LGE.
  • LVEFCMRI, GLS, GWI, GCW, and GWE remained independent predictors of LV myocardial fibrosis after adjusting for age and LV end-systolic volume index.
  • Receiver operating characteristic (ROC) analysis indicated that LVEFCMRI and GCW demonstrated higher accuracy, sensitivity, and specificity in predicting LV myocardial fibrosis than GLS.

Conclusions:

  • Non-invasive global myocardial work indices (GWI, GCW, GWE) and LVEFCMRI, GLS are significant predictors of LV myocardial fibrosis in DCM.
  • LVEFCMRI and GCW exhibit superior predictive performance for LV myocardial fibrosis compared to GLS.
  • These findings support the utility of non-invasive myocardial work analysis in assessing cardiac fibrosis in DCM.

Keywords:
dilated cardiomyopathyechocardiographyleft ventricular systolic functionmagnetic resonance imagingmyocardial fibrosismyocardial work

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