Quantifying myocardial function characteristic with myocardial work measurement in patients with different aortic...

Assessing subclinical myocardial dysfunction in aortic regurgitation (AR) with preserved left ventricular ejection fraction (LVEF) is challenging due to load-dependent conventional parameters. Non-invasive myocardial work (MW) integrates left ventricular pressure and strain to provide afterload-adjusted performance indices. This study aimed to characterize MW across AR severity in patients with preserved LVEF.

We prospectively enroled 130 patients categorized as control (n = 30), mild (n = 30), moderate (n = 34), and severe (n = 36) according to guidelines. MW parameters were assessed using Vivid E95 ultrasound and included: global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE).

Compared to controls, AR groups demonstrated reduced GWI (p < 0.001), with severe AR group significantly lower than mild/moderate groups. GCW (p < 0.001) decreased in moderate/severe AR (p < 0.001). GWW progressively increased (p < 0.001) and GWE decreased (p < 0.001) from mild to severe AR. ROC analysis revealed excellent discrimination between severe AR and controls: GWI (AUC: 0.892), GCW (AUC: 0.806), GWW (AUC: 0.961), and GWE (AUC: 0.982). Intra- and inter-observer variability was excellent (ICCs > 0.80).

Non-invasive MW indices, particularly GWW and GWE, progressively deteriorate with AR severity in preserved LVEF patients. These findings provide novel, physiology-based insights into myocardial energetic efficiency in chronic volume overload. MW parameters may offer incremental value in functional evaluation, potentially aiding subclinical dysfunction identification. Future large-scale, longitudinal studies are warranted to validate prognostic utility and role in optimizing intervention timing.