NON-INVASIVE MYOCARDIAL WORK INDICES BY PRESSURE-STRAIN LOOPS : A NEW TOOL TO STUDY LEFT VENTRICLE PERFORMANCE

Myocardial strain analysis has emerged in the last decade as a reliable tool for studying myocardial mechanics, adding information on cardiac performance when compared with traditional parameters of left ventricle (LV) systolic function, such as ejection fraction (EF). However, their relative load dependency makes the myocardial deformation indices unable to account for changes in pre- and afterload. Myocardial work (MW) is emerging as an alternative tool for studying LV myocardial systolic function, because it incorporates both deformation and load into its analysis. In order to have more insights on the novel non-invasive MW indices, we proposed: 1) to establish reference ranges of MW indices in healthy adults and to examine the influence of age and gender on normal reference limits. This study was part of the European Association of Cardiovascular Imaging (EACVI) Normal Reference Ranges Study (NORRE) study. It is the first one study, to date, to provide reference ranges for non-invasive MW indices (Paper 1). 2) to investigate main correlations between MW indices and LV size, parameters of LV systolic and diastolic function in the same NORRE population (Paper 2). 3) to evaluate MW indices in a population of patients with hypertrophic cardiomyopathy (HCM), including also the obstructive form. In particular we proposed a method to obtain MW in obstructive HCM, we evaluated MW according to hypertrophy distribution and investigated main correlations between MW indices and LV size and function and left atrial longitudinal strain in this population (Paper 3).