Open Access

Prognostic implications of left ventricular myocardial work indices in cardiac amyloidosis

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Date: 12 June 2020
Journal: European Heart Journal - Cardiovascular Imaging , Volume 22 , Issue 6 , Pages 695 - 704
Authors: T. Clemmensen , H. Eiskjær , B. Ladefoged , F. Mikkelsen , J. Sørensen , S. Granstam , S. Rosengren , F. Flachskampf , S. Poulsen

ESC Journals

AbstractAims

Left ventricular (LV) myocardial work index (LVMWI) derived from pressure–strain analysis resembles a novel non-invasive method for LV function evaluation. LV global longitudinal strain (LVGLS) has proven beneficial for risk stratification in cardiac amyloidosis (CA) patients. This study aimed to evaluate the potential additive value of LVMWI for outcome prediction in CA patients.

Methods and results

We enrolled 100 CA patients in the period 2014–19 from Aarhus University Hospital, Denmark and Uppsala University Hospital, Sweden. All patients underwent comprehensive echocardiographic evaluation and were prospectively followed until censuring date on 31 March 2019 or death. During follow-up, we registered major adverse cardiac events (MACE) comprising heart failure requiring hospitalization and all-cause mortality. The median follow-up was 490 (228–895) days. During follow-up, a total of 42% of patients experienced MACE and 29% died. Patients with LVMWI <1043 mmHg% had higher MACE risk than patients with LVMWI >1043 mmHg% [hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.2–4.3; P = 0.01]. Furthermore, patients with LVMWI <1039 mmHg% also had higher all-cause mortality risk than patients with LVMWI >1039 mmHg% (HR 2.6, 95% CI 1.2–5.5; P < 0.05). Moreover, the apical-to-basal segmental work ratio was a significant MACE and all-cause mortality predictor. By combining LVMWI and apical-to-basal segmental work ratio, we obtained an independent model for all-cause mortality prediction (high vs. low risk: HR 6.4, 95% CI 2.4–17.1; P < 0.0001). In contrast, LVGLS did not predict all-cause mortality.

Conclusion

LV myocardial work may be of prognostic value in CA patients by predicting both MACE and all-cause mortality.

About the contributors

Tor Skibsted Clemmensen

Aarhus (Aarhus University Hospital)

Role: Author

Hans Eiskjær

Role: Author

Bertil Ladefoged

Role: Author