Dynamics of Left Ventricular Myocardial Work in Patients Hospitalized for Acute Heart Failure |
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| Institution: | 1. Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany;2. Department of Medicine I, University Hospital Würzburg, Würzburg, Germany;3. Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany;4. Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany;1. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;2. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois;4. Pritzker School of Law, Institute for Policy Research, Kellogg School of Management, Northwestern University, Chicago, Illinois;5. Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;1. Department of Cardiology, Baskent University, Ankara, Turkey;2. Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania;1. Department of Medicine, Division of Cardiology, Columbia University, New York, New York;2. Department of Medicine, Division of Cardiology, University of Washington, Washington;3. Department of Neurology, Columbia University, New York, New York;4. Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York;5. Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York;6. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota;1. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK;2. Universitaetsklinikum, RWTH, Aachen, Germany;1. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada;2. National Heart Centre and Duke-National University of Singapore, Singapore, Singapore;3. Department of Laboratory Medicine and Pathology, Hennepin Healthcare/HCMC, Minneapolis, Minnesota;4. USA and Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota;5. Department of Medical Biochemistry and Pharmacology and Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;6. Department of Clinical Science, University of Bergen, Bergen, Norway;7. Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK;8. Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK;9. Healthcare Sciences Department, Manchester Metropolitan University, Manchester, UK;10. Department of Clinical Chemistry and Transfusion Medicine, University of Gothenburg, Gothenburg, Sweden;11. Department of Clinical Blood Sciences and Cardiology, St George''s University Hospitals NHS Foundation Trust and St George''s University of London, London, UK;12. Servicio de Bioquímica Clínica, Institut d''Investigacions Biomèdiques Sant Pau, Barcelona, Spain;13. Departamento de Bioquímica y Biología Molecular, Universidad Autònoma de Barcelona, Barcelona, Spain;14. Department of Cardiology, Akershus University Hospital, Lørenskog, Norway;15. Institute of Clinical Medicine, University of Oslo, Oslo, Norway;16. Departments of Laboratory Medicine and Pathology and Cardiology, Mayo Clinic, Rochester, Minnesota |
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| Abstract: | BackgroundThe left ventricular ejection fraction (LVEF) is the most commonly used measure describing pumping efficiency, but it is heavily dependent on loading conditions and therefore not well-suited to study pathophysiologic changes. The novel concept of echocardiography-derived myocardial work (MyW) overcomes this disadvantage as it is based on LV pressure–strain loops. We tracked the in-hospital changes of indices of MyW in patients admitted for acute heart failure (AHF) in relation to their recompensation status and explored the prognostic utility of MyW indicesMethods and ResultsWe studied 126 patients admitted for AHF (mean 73 ± 12 years, 37% female, 40% with a reduced LVEF <40%]), providing pairs of echocardiograms obtained both on hospital admission and prior to discharge. The following MyW indices were derived: global constructive and wasted work (GCW, GWW), global work index (GWI), and global work efficiency. In patients with HF with reduced ejection fraction with decreasing N-terminal prohormone B-natriuretic peptide levels during hospitalization, the GCW and GWI improved significantly, whereas the GWW remained unchanged. In patients with HF with preserved ejection fraction, the GCW and GWI were unchanged; however, in patients with no decrease or eventual increase in N-terminal prohormone B-natriuretic peptide, we observed an increase in GWW. In all patients with AHF, higher values of GWW were associated with a higher risk of death or rehospitalization within 6 months after discharge (per 10-point increment hazard ratio 1.035, 95% confidence interval 1.005–1.065).ConclusionsOur results suggest differential myocardial responses to decompensation and recompensation, depending on the HF phenotype in patients presenting with AHF. The GWW predicted the 6-month prognosis in these patients, regardless of LVEF. Future studies in larger cohorts need to confirm our results and identify determinants of short-term and longer term changes in MyW. |
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