Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA.
Cardiovascular Research, Advocate Aurora Research, Advocate Aurora Health, 960 N. 12th Street, Suite 4120, Milwaukee, WI53233, USA.
Eur Heart J Cardiovasc Imaging. 2021 Jun 22;22(7):744-750. doi: 10.1093/ehjci/jeab043.
Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension.
Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure-strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P < 0.001), and GWW (P < 0.001).
Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.
心肌做功（MW）是一种可用于临床评估左心室（LV）压力和变形的新型参数。我们旨在区分高血压与非高血压患者的整体 MW 指数模式，并观察高血压各分类之间的差异。
65 例高血压患者（平均年龄 65±13 岁；30 名男性）和 15 名对照者（平均年龄 38±12 岁；7 名男性）在静息状态下接受经胸超声心动图检查。根据 2017 年美国心脏病学会指南，高血压患者分为 1 期（n=32）和 2 期（n=33）高血压。排除标准为心肌变形分析图像质量不佳、射血分数降低、瓣膜性心脏病、心内分流和心律失常。利用斑点追踪超声心动图的专有软件从 LV 压力-应变环中估计整体做功指数（GWI）、整体构建功（GCW）、整体浪费功（GWW）和整体做功效率。LV 收缩和舒张压力通过无创肱动脉袖带压力估计。两组间 LV 收缩期和舒张期应变无统计学差异，但在对照组与高血压两组之间，GWI（P=0.01）、GCW（P<0.001）和 GWW（P<0.001）存在统计学差异。
非侵入性 MW 分析可更好地了解在增加后负荷条件下 LV 的反应。MW 是高血压患者 LV 收缩功能的一种高级评估方法，比 LV 射血分数和整体纵向应变更能深入了解 LV 压力与收缩性之间的关系，而后者与负荷依赖性有关。
