PMID- 34222382 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210706 IS - 2297-055X (Print) IS - 2297-055X (Electronic) IS - 2297-055X (Linking) VI - 8 DP - 2021 TI - Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure. PG - 691611 LID - 10.3389/fcvm.2021.691611 [doi] LID - 691611 AB - Objectives: The aim of this study was to investigate whether echocardiographic assessment of myocardial work is a predictor of outcome in advanced heart failure. Background: Global work index (GWI) and global constructive work (GCW) are calculated by means of speckle tracking, blood pressure measurement, and a normalized reference curve. Their prognostic value in advanced heart failure is unknown. Methods: Cardiopulmonary exercise testing and echocardiography with assessment of GWI and GCW was performed in patients with advanced heart failure caused by ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular assist device, or heart transplantation. Results: The median patient age was 54 years (interquartile range [IQR]: 48-59.9). The mean left ventricular ejection fraction was 27.8 +/- 8.2%, the median NT-proBNP was 1,210 pg/ml (IQR: 435-3,696). The mean GWI was 603 +/- 329 mmHg% and the mean GCW was 742 +/- 363 mmHg%. The correlation between peak oxygen uptake and GWI as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p = 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months (IQR: 12-18.5). Thirty one patients met the combined endpoint: Four patients died, eight underwent transplantation, and 19 underwent implantation of a left ventricular assist device. In the multivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI (hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77-0.94; p = 0.002) as well as GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79-0.94; p = 0.001) were identified as independent predictors of the endpoint. The cut-off value for predicting the outcome was 455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and 530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%). Conclusions: GWI and GCW are powerful predictors of outcome in patients with advanced heart failure. CI - Copyright (c) 2021 Hedwig, Nemchyna, Stein, Knosalla, Merke, Knebel, Hagendorff, Schoenrath, Falk and Knierim. FAU - Hedwig, Felix AU - Hedwig F AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. FAU - Nemchyna, Olena AU - Nemchyna O AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. FAU - Stein, Julia AU - Stein J AD - DHZB Dienstleistungs GmbH, Berlin, Germany. FAU - Knosalla, Christoph AU - Knosalla C AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. FAU - Merke, Nicolas AU - Merke N AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. FAU - Knebel, Fabian AU - Knebel F AD - Department of Cardiology and Angiology, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. FAU - Hagendorff, Andreas AU - Hagendorff A AD - Department of Cardiology, Klinik und Poliklinik fur Kardiologie, University of Leipzig, Leipzig, Germany. FAU - Schoenrath, Felix AU - Schoenrath F AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. FAU - Falk, Volkmar AU - Falk V AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. AD - Department of Cardiovascular Surgery, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. AD - Eidgenossische Technische Hochschule Zurich, Department of Health Sciences and Technology, Translational Cardiovascular Technology, Zurich, Switzerland. FAU - Knierim, Jan AU - Knierim J AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. LA - eng PT - Journal Article DEP - 20210618 PL - Switzerland TA - Front Cardiovasc Med JT - Frontiers in cardiovascular medicine JID - 101653388 PMC - PMC8249920 OTO - NOTNLM OT - constructive work OT - heart failure OT - myocardial work OT - outcome OT - prognosis OT - strain COIS- AH receives lecture fees from GE Healthcare, Astra Zeneca, Novartis, and Pfizer. VF declares relevant financial activities outside the submitted work from Biotronik SE & Co., Abbott GmbH & Co. KG, Boston Scientific, Edwards Lifesciences, Medtronic, Berlin Heart, Novartis Pharma GmbH, JOTEC GmbH, and Zurich Heart. JS was employed by company DHZB Dienstleistungs GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2021/07/06 06:00 MHDA- 2021/07/06 06:01 PMCR- 2021/01/01 CRDT- 2021/07/05 10:15 PHST- 2021/04/06 00:00 [received] PHST- 2021/05/27 00:00 [accepted] PHST- 2021/07/05 10:15 [entrez] PHST- 2021/07/06 06:00 [pubmed] PHST- 2021/07/06 06:01 [medline] PHST- 2021/01/01 00:00 [pmc-release] AID - 10.3389/fcvm.2021.691611 [doi] PST - epublish SO - Front Cardiovasc Med. 2021 Jun 18;8:691611. doi: 10.3389/fcvm.2021.691611. eCollection 2021.