Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark.
The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen 2400, Denmark.
Eur Heart J Cardiovasc Imaging. 2024 Feb 22;25(3):413-424. doi: 10.1093/ehjci/jead292.
Pressure-strain loop (PSL) analysis is a novel echocardiographic tool capable of assessing myocardial work non-invasively. In this study, we aim to evaluate the prognostic value of myocardial work indices in the general population.
This was a prospective community-based cohort study (n = 4466). PSL analyses were performed to acquire global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency (GWE). The endpoint was a composite of heart failure or cardiovascular death (HF/CVD). Survival analysis was applied. A total of 3932 participants were included in this analysis (median age: 58 years, 43% men). Of these, 124 (3%) experienced the outcome during a median follow-up period of 3.5 years [interquartile range (IQR): 2.6-4.4 years]. Hypertension significantly modified the association between all work indices and outcome (P for interaction < 0.05), such that work indices posed a higher risk of outcome in non-hypertensive than in hypertensive participants. After adjusting for Atherosclerosis Risk in Communities (ARIC)-HF risk variables, all work indices predicted outcome in non-hypertensive participants, but only GWI, GCW, and GWE predicted outcome in hypertensive participants [GWI: hazard ratio (HR) = 1.12 (1.07-1.16), per 100 mmHg% decrease; GCW: HR = 1.12 (1.08-1.17), per 100 mmHg% decrease; GWE: HR = 1.08 (1.04-1.12), per 1% decrease]. Only GWE significantly increased C-statistics when added to ARIC-HF risk variables in hypertensive participants (C-stat 0.865 vs. 0.877, P for increment = 0.003).
Hypertension modifies the association between myocardial work indices and HF/CVD in the general population. All work indices are associated with outcome in normotensive participants. GWI, GCW, and GWE are independently associated with outcome in hypertension, but only GWE improves risk prediction.
压力-应变环（PSL）分析是一种新型的超声心动图工具，能够无创评估心肌做功。本研究旨在评估心肌做功指标在普通人群中的预后价值。
这是一项前瞻性的基于社区的队列研究（n=4466）。进行 PSL 分析以获取整体做功指数（GWI）、整体有效功（GCW）、整体无效功和整体工作效率（GWE）。终点是心力衰竭或心血管死亡（HF/CVD）的复合事件。采用生存分析。共有 3932 名参与者纳入本分析（中位年龄：58 岁，43%为男性）。其中，124 人（3%）在中位随访 3.5 年期间（IQR：2.6-4.4 年）发生了该结局。高血压显著改变了所有工作指标与结局之间的关系（交互 P 值<0.05），表明在非高血压参与者中，工作指标与结局的相关性更高。在校正 Atherosclerosis Risk in Communities（ARIC）-HF 风险变量后，所有工作指标均能预测非高血压参与者的结局，但仅 GWI、GCW 和 GWE 能预测高血压参与者的结局[GWI：危险比（HR）=1.12（1.07-1.16），每降低 100mmHg%；GCW：HR=1.12（1.08-1.17），每降低 100mmHg%；GWE：HR=1.08（1.04-1.12），每降低 1%]。仅 GWE 在高血压参与者中加入 ARIC-HF 风险变量后显著增加了 C 统计量（C 统计量 0.865 比 0.877，增量 P 值=0.003）。
高血压改变了心肌做功指标与普通人群 HF/CVD 之间的关联。所有工作指标与正常血压参与者的结局相关。GWI、GCW 和 GWE 与高血压患者的结局独立相关，但只有 GWE 能改善风险预测。
