Echocardiography. 2026 Aug;43(8):e70604. doi: 10.1111/echo.70604.
ABSTRACT
BACKGROUND: Left ventricular (LV) myocardial work (MW) assessment is a novel non-invasive tool for relatively load-independent assessment of LV myocardial contractile function. In this study, we compared LVMW characteristics across three conditions- aortic stenosis (AS), chronic kidney disease (CKD), and cardiac amyloidosis (CA)- that share increased LV wall thickness but arise from fundamentally different pathophysiological mechanisms.
METHODS: The study included 25 consecutive patients in each of the following groups: severe AS scheduled for aortic valve replacement, CKD on maintenance hemodialysis, and light-chain CA. An additional group of twenty-five apparently healthy individuals served as controls. LV global longitudinal strain (GLS) and MW were quantified using speckle tracking echocardiography.
RESULTS: LV mass was significantly increased in all three disease groups compared with controls. LV ejection fraction was mildly reduced but similar in all the three disease groups. LVGLS was impaired in all patient groups, with the greatest reduction observed in CA. Global work index and global constructive work were highest in patients with AS [1815 mmHg% (interquartile range or IQR 1271, 2061) and 2094 mmHg% (IQR 1815, 2521), respectively] and lowest in patients with CA [804 mmHg% (IQR 596, 1091) and 1117 mmHg% (IQR 810, 1256)], while CKD patients demonstrated intermediate values. Multivariable analyses adjusting for demographic and hemodynamic variables confirmed these findings.
CONCLUSION: Our study demonstrates distinct patterns of MW across conditions associated with increased LV wall thickness. These findings support the complementary role of MW assessment in the comprehensive evaluation of LV function and myocardial dysfunction. Larger prospective studies are required to establish its diagnostic and prognostic utility.
PMID:42626867 | DOI:10.1111/echo.70604