Long-term prognostic value of myocardial work analysis across obesity stages: insights from a community-based study

Obesity and overweight are major contributors to cardiovascular disease and adverse outcomes, yet subclinical systolic dysfunction in low-risk individuals often remains undetected by conventional echocardiographic metrics. Myocardial work (MW) analysis offers a more sensitive assessment of left ventricular (LV) function. Thus, we aimed to assess the prognostic value of MW indices in a low-risk, community-based cohort with different stages of obesity.

We retrospectively identified 1330 volunteers from the Budakalász population-based screening program stratified into 3 groups: patients with normal weight, overweight, and obesity based on BMI. All underwent 2D echocardiography to measure LV ejection fraction (EF), LV global longitudinal strain (GLS), global MW index (GWI), global wasted work (GWW), and global MW efficiency (GWE). The primary endpoint was all-cause mortality over a median follow-up of 11 years.

During follow-up, 138 (10.4%) participants died. LVEF was not predictive of outcome. By univariable Cox regression analysis, GWI was a predictor of outcomes, alongside GWW, GWE, and GLS in the total cohort. In normal weight group, only GLS was a predictor. In the group with overweight, GLS, GWE (HR 0.917 [95%CI 0.874-0.963], p < 0.00) and GWW (HR 1.341 [95%CI 1.121-1.604], p = 0.001) were predictors of mortality. Among patients with obesity, GWI was the only significant predictor (HR 0.929 [95%CI 0.875-0.986], p = 0.015). In patients with overweight and obesity with GWI values below the standard cut-off of 1292 mmHg%, the risk of all-cause mortality was more than 2 times higher.

Myocardial work metrics were significant predictors of long-term outcomes in low-risk individuals with different stages of obesity. Our findings highlight that conventional echocardiographic metrics may underestimate cardiovascular risk in patients with overweight and obesity.