Global myocardial work: A new way to detect subclinical myocardial dysfunction with normal left ventricle ejection fraction in essential hypertension patients: Compared with myocardial layer-specific strain analysis

Objectives: The aim of this study was to determine whether global myocardial work (MW), derived from non-invasive left ventricle (LV) pressure-strain loops (PSL) at rest, could predict subclinical LV myocardial dysfunction in preserved left ventricular ejection fraction (LVEF) essential hypertension (EHT) patients.

Methods: A total of 105 untreated EHT patients and 55 normal controls were enrolled in this study. Apical 4-, 3- and 2-chamber views were acquired by two-dimensional echocardiography. The peak systolic myocardial layer-specific longitudinal strain (epimyocardial: GLSEpi; middle layer: GLSMid; and endomyocardial: GLSEndo), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and myocardial work efficiency (GWE) were generated by speckle-tracking echocardiography (STE).

Results: The values of GLSEpi, GLSMid, and GLSEndo were significantly lower in EHT patients with LVH than in EHT patients without LVH and normal controls. GWW was significantly increased in EHT patients with LVH compared with without LVH and normal subjects, while GWE was significantly reduced in EHT patients with LVH compared with without LVH and normal subjects. ROC analysis showed that combined global MW values were a more sensitive predictor for detecting the accuracy of LV subclinical dysfunction in EHT patients than layer-specific GLS.

Conclusion: From the research, we conclude that global MW is more sensitive to layer-specific GLS in its ability to detect subclinical LV dysfunction even in EHT patients even without LVH.