Chen Peng, Kiriakou Christina, Aurich Matthias, Greiner Sebastian, Maliandi Gabriele, Müller-Hennessen Matthias, Giannitsis Evangelos, Meder Benjamin, Frey Norbert, Pleger Sven, Mereles Derliz
Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.
Int J Cardiovasc Imaging. 2025 Sep 26. doi: 10.1007/s10554-025-03522-7.
Myocardial work indices (MW) have been validated with respect to their efficiency for predicting cardiac events in patients with heart failure. However, the measurement of MW requires specific vendor software that may not be ubiquitous accessible. We aimed to explore the feasibility of using a nonproprietary method, peak myocardial work index (PMW) = systolic blood pressure * global longitudinal strain, as a potential substitute to global constructive work (GCW) for the assessment of left ventricular function. A retrospective analysis of 116 patients with dilated cardiomyopathy (DCM) and an equal number of age- and sex-matched healthy controls examined from June 2009 to July 2014 was conducted. Compared to healthy controls, the PMW index and GCW were significantly lower in DCM patients: 1371 ± 541 vs. 2520 ± 361 mm Hg%, 1318 ± 502 vs. 2322 ± 333 mm Hg%, respectively (p < 0.001 for each). Additionally, PMW showed an excellent correlation with GCW (r = 0.99, p < 0.001). During a mean follow-up time of 5.1 years, 34 patients (29.3%) reached the composite endpoints: 5 patients received cardiac transplantation, 17 patients were hospitalized due to heart failure, 9 patients received appropriate ICD therapy and 3 patients died. PMW per 50 mm Hg% increase (HR = 0.92, 95%CI 0.89-0.96, p < 0.001) and GCW per 50 mm Hg% increase (HR = 0.91, 95%CI 0.88-0.95, p < 0.001) performed comparably in predicting adverse outcomes in DCM patients in the univariate Cox regression analyses. PMW and GCW were the independent prognostic factors after adjusting for significant parameters of the univariate analysis. Patients with PMW < 1,286 mm Hg% (HR = 3.71, 95%CI 1.18-11.63, p = 0.025) and GCW < 1,238 mm Hg% (HR = 4.8, 95%CI 1.57-14.68, p = 0.006) had higher risks of MACE. PMW index might serve as an alternative echocardiographic method for evaluating left ventricular systolic function, providing similar diagnostic and prognostic capacity comparable to GCW.
心肌作功指数（MW）在预测心力衰竭患者心脏事件的有效性方面已得到验证。然而，MW的测量需要特定的供应商软件，可能并非随处可得。我们旨在探索使用一种非专利方法，即峰值心肌作功指数（PMW）=收缩压×整体纵向应变，作为评估左心室功能的整体建设性作功（GCW）的潜在替代方法的可行性。对2009年6月至2014年7月期间检查的116例扩张型心肌病（DCM）患者和同等数量年龄及性别匹配的健康对照进行了回顾性分析。与健康对照相比，DCM患者的PMW指数和GCW显著更低：分别为1371±541 vs. 2520±361 mmHg%，1318±502 vs. 2322±333 mmHg%（每组p<0.001）。此外，PMW与GCW显示出极好的相关性（r = 0.99，p<0.001）。在平均5.1年的随访时间内，34例患者（29.3%）达到复合终点：5例接受心脏移植，17例因心力衰竭住院，9例接受适当的植入式心律转复除颤器（ICD）治疗，3例死亡。在单变量Cox回归分析中，PMW每增加50 mmHg%（HR = 0.92，95%CI 0.89 - 0.96，p<0.001）和GCW每增加50 mmHg%（HR = 0.91，95%CI 0.88 - 0.95，p<0.001）在预测DCM患者不良结局方面表现相当。在对单变量分析的显著参数进行调整后，PMW和GCW是独立的预后因素。PMW<1286 mmHg%（HR = 3.71，95%CI 1.18 - 11.63，p = 0.025）和GCW<1238 mmHg%（HR = 4.8，95%CI 1.57 - 14.68，p = 0.006）的患者发生主要不良心血管事件（MACE）的风险更高。PMW指数可作为评估左心室收缩功能的一种替代超声心动图方法，提供与GCW相当的诊断和预后能力。
