Characteristics of Myocardial Work Indices in Patients with Aortic Valve Stenosis

Abstract

No reports compared four indices of myocardial work based on aortic valve stenosis (AS) severity. This study aimed to characterize the four myocardial work indices and global longitudinal strain (GLS) in AS with left ventricular ejection fraction (LVEF) > 50%, and to investigate the association of these indices with severe AS.

We measured global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), and GLS in 154 patients. These indices were compared among three groups: normal, mild-to-moderate, and severe AS.

GWI and GCW were significantly higher in mild-to-moderate and severe AS groups than in normal group. GWW was significantly higher in severe AS group than in normal and mild-to-moderate AS groups. GWE and GLS were significantly lower in severe AS group than in normal and mild-to-moderate AS groups. The ability to discriminate severe AS was examined using receiver operating characteristic analysis, and GWW demonstrated the largest area under the curve. Multivariate logistic regression analysis demonstrated that the four myocardial work indices and GLS were significantly associated with severe AS after adjusting for age, height, and brachial systolic blood pressure.

In conclusions, GWI, GCW, and GWW, were significantly higher, while GWE and GLS were significantly lower in the severe AS group than in the normal group. These findings suggest that the four indices of myocardial work are valuable in detecting the impairment of left ventricular myocardial workload due to severe AS in patients with preserved LVEF.