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Non-Invasive Myocardial Work Detects Extensive Coronary Disease in Orthotopic Heart Transplant Patients
Rebeca Manrique Antón1, Marina Pascual Izco1,2, Agnés Díaz Dorronsoro1,2
1Department of Cardiology and Cardiac Surgery, Clínica Universidad de Navarra, University of Navarra, Av. De Pío XII 36, 31007 Pamplona, Spain.
Insights
Myocardial work (MW) indices, specifically global wasted work (GWW) and global work efficiency (GWE), can non-invasively detect extensive cardiac allograft vasculopathy (CAV) in heart transplant recipients. These findings may aid in identifying patients with significant coronary artery disease burden.
Area of Science:
- Cardiology
- Transplantation Immunology
- Medical Imaging
Background:
- Cardiac allograft vasculopathy (CAV) is a major cause of graft failure and mortality after heart transplantation.
- Early detection of extensive coronary artery disease is crucial for patient outcomes.
Purpose of the Study:
- To evaluate myocardial work (MW) indices as a non-invasive tool for detecting extensive coronary artery disease in orthotopic heart transplantation (OHT) recipients.
- To assess the ability of global wasted work (GWW) and global work efficiency (GWE) to identify OHT recipients with a high burden of coronary disease.
Main Methods:
- Prospective study of 55 OHT recipients undergoing coronary computed tomography angiography (CCTA) and transthoracic echocardiography (TTE).
- Myocardial work (MW) indices, including global longitudinal strain (GLS), global wasted work (GWW), and global work efficiency (GWE), were derived from TTE.
- Patients were categorized based on CCTA findings into those with extensive coronary artery disease (≥ 4 segments) and those without (< 4 segments).
Main Results:
- Extensive coronary disease was identified in 38 OHT recipients by CCTA.
- Significant differences in GWW and GWE were observed between groups with and without extensive coronary artery disease.
- Optimal thresholds for GWW (> 88 mmHg%) and GWE (< 94%) effectively identified patients with extensive coronary disease, showing odds ratios of 4.61 and 3.68, respectively.
Conclusions:
- Global wasted work (GWW) and global work efficiency (GWE) show strong performance in identifying OHT recipients with extensive coronary artery disease.
- These myocardial work indices offer a potential non-invasive method for detecting significant cardiac allograft vasculopathy (CAV).
- Further validation in larger cohorts is warranted to confirm these findings.
Background/Objectives:
Cardiac allograft vasculopathy (CAV) remains a prevalent and serious long-term complication following orthotopic heart transplantation (OHT), contributing substantially to graft failure and patient mortality. Given the adverse prognostic impact of extensive coronary artery involvement, this study investigates whether myocardial work (MW) indices can serve as a non-invasive tool to detect OHT recipients with a high burden of coronary disease.
Methods:
In this prospective study, 55 OHT recipients underwent paired evaluations with coronary computed tomography angiography (CCTA) and transthoracic echocardiography (TTE) during routine follow-up. From the echocardiograms, global longitudinal strain (GLS) of the left ventricle (LV) and myocardial work (MW) indices were derived. Patients were classified into two groups according to CCTA findings: those without extensive coronary artery disease (disease affecting fewer than four coronary segments or none, OHT < 4) and those with extensive disease (disease of four or more coronary artery segments, OHT ≥ 4).
Results:
CCTA revealed extensive coronary disease in 38 OHT recipients, while 17 had involvement of fewer than four segments or none. Between-group comparisons showed significant differences in global wasted work (GWW, energy expended without generating forward flow) and global work efficiency (GWE, the percentage of constructive work relative to total work). Using the Youden Index, the optimal thresholds for identifying extensive disease were GWW > 88 mmHg% and GWE < 94%. Patients exceeding these thresholds had a markedly higher probability of having ≥ 4 affected segments, with ORs of 4.61 for pathological GWW and 3.68 for pathological GWE compared to those with normal values.
Conclusions:
GWW and GWE demonstrated the strongest performance for identifying OHT recipients with extensive coronary disease. If confirmed in larger cohorts, these indices could offer a practical, non-invasive approach for detecting extensive CAV.
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