eCite Digital Repository

Usefulness of myocardial work measurement in the assessment of left ventricular systolic reserve response to spironolactone in heart failure with preserved ejection fraction

Citation

Przewlocka-Kosmala, M and Marwick, TH and Mysiak, A and Kosowski, W and Kosmala, W, Usefulness of myocardial work measurement in the assessment of left ventricular systolic reserve response to spironolactone in heart failure with preserved ejection fraction, European Heart Journal - Cardiovascular Imaging pp. 1-9. ISSN 2047-2404 (2019) [Refereed Article]

Copyright Statement

Copyright 2019 The Authors

DOI: doi:10.1093/ehjci/jez027

Abstract

Aims: Improvement in left ventricular (LV) systolic reserve, including exertional increase in global longitudinal strain (GLS), may contribute to the clinical benefit from therapeutic interventions in heart failure with preserved ejection fraction (HFpEF). However, GLS is an afterload-dependent parameter, and its measurements may not adequately reflect myocardial contractility recruitment with exercise. The estimation of myocardial work (MW) allows correction of GLS for changing afterload. We sought to investigate the associations of GLS and MW parameters with the response of exercise capacity to spironolactone in HFpEF.

Methods and Results: We analysed 114 patients (67  8 years) participating in the STRUCTURE study (57 randomized to spironolactone and 57 to placebo). Resting and immediately post-exercise echocardiograms were performed at baseline and at 6-month follow-up. The following indices of MW were assessed: global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. The amelioration of exercise intolerance at follow-up in the spironolactone group was accompanied by a significant improvement in exertional increase in GCW (P = 0.002) but not in GLS and other MW parameters. Increase in exercise capacity at 6 months was independently correlated with change in exertional increase in GCW from baseline to follow-up (β = 0.24; P = 0.009) but not with GLS (P = 0.14); however, no significant interaction with the use of spironolactone on peak VO2 was found (P = 0.97).

Conclusion: GCW as a measure of LV contractile response to exertion is a better determinant of exercise capacity in HFpEF than GLS. Improvement in functional capacity during follow-up is associated with improvement in exertional increment of GCW.

Item Details

Item Type:Refereed Article
Keywords:HFpEF, spironolactone, global longitudinal strain, myocardial work
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
UTAS Author:Marwick, TH (Professor Tom Marwick)
UTAS Author:Kosmala, W (Professor Wojciech Kosmala)
ID Code:134988
Year Published:2019
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-09-18
Last Modified:2019-10-10
Downloads:0

Repository Staff Only: item control page