Normal Values for Myocardial Work Indices Derived From Pressure-Strain Loop Analyses: From the CCHS

Author:

Olsen Flemming Javier123ORCID,Skaarup Kristoffer Grundtvig12ORCID,Lassen Mats Christian Højbjerg12ORCID,Johansen Niklas Dyrby123ORCID,Sengeløv Morten123,Jensen Gorm Boje2,Schnohr Peter2,Marott Jacob Louis2ORCID,Søgaard Peter45,Gislason Gunnar14ORCID,Svendsen Jesper Hastrup46ORCID,Møgelvang Rasmus467,Aalen John Moene8,Remme Espen Wattenberg89,Smiseth Otto Armin8,Biering-Sørensen Tor123ORCID

Affiliation:

1. Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Hellerup, Denmark (F.J.O., K.G.S., M.C.H.L., N.D.J., M.S., G.G., T.B.-S.).

2. The Copenhagen City Heart Study, Copenhagen University Hospital–Frederiksberg and Bispebjerg Hospital, Denmark (F.J.O., K.G.S., M.C.H.L., N.D.J., M.S., G.B.J., P.S., J.L.M., T.B.-S.).

3. Department of Biomedical Sciences (F.J.O., N.D.J., M.S., T.B.-S.), University of Copenhagen, Denmark.

4. Department of Clinical Medicine (P.S., G.G., J.H.S., R.M.), University of Copenhagen, Denmark.

5. Department of Cardiology, Copenhagen University Hospital–North Zealand Hospital, Hilleroed, Denmark (P.S.).

6. Department of Cardiology, Copenhagen University Hospital–Rigshospitalet, Denmark (J.H.S., R.M.).

7. Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense (R.M.).

8. Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo University Hospital and University of Oslo, Norway (J.M.A., E.W.R., O.A.S.).

9. The Intervention Centre, Oslo University Hospital, Rikshospitalet, Norway (E.W.R.).

Abstract

Background: Pressure-strain loop analyses is a noninvasive technique capable of evaluating myocardial work. Reference values are needed to benchmark these myocardial work indices for clinical practice. Methods: Healthy participants from a general population study were used to establish reference values for global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) measured by pressure-strain loop analyses. The relation to age and sex was examined. We furthermore examined the proportion of abnormal work indices according to low, intermediate, and high cardiovascular risk by the Framingham risk score. Results: The healthy sample consisted of 1827 participants (median age, 45 years; 39% men). Lower reference values were GWI, 1576 mm Hg%; GCW, 1708 mm Hg%; and GWE, 93.0% and upper reference value for GWW was 159 mm Hg%. Women exhibited significantly higher GWI, GCW, and GWW and lower GWE. Sex significantly modified the association between all indices and age ( P for interaction: 0.001 for GWI, 0.009 for GCW, 0.003 for GWW, and 0.009 for GWE). For men, only GCW increased with age, whereas the other indices did not change with age. For women, GCW increased linearly with increasing age, whereas GWI, GWW, and GWE changed in a curvilinear fashion with age such that GWI increased in younger participants, GWW increased in elderly, and GWE declined concordantly. Abnormalities in myocardial work indices became more frequent with increasing Framingham risk score category (abnormal GWI: 2% versus 4% versus 5%, P =0.001; abnormal GCW: 2% versus 3% versus 4%, P =0.006; abnormal GWW: 3% versus 6% versus 11%, P <0.001; abnormal GWE: 3% versus 4% versus 11%, P <0.001). Conclusions: Myocardial work indices differ between sexes and change with age in a sex-dependent manner. Accordingly, we established age- and sex-specific reference values from a general population sample. Abnormal work indices become more frequent with higher clinical risk. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02993172.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging

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