PhD Scientific Days 2025

Poster Session I. - T: Cardiovascular Medicine and Research

Pressure-volume-strain-derived myocardial work: a novel prognostic marker in patients undergoing transcatheter aortic valve replacement

Name of the presenter

Turschl Timea Katalin

Institute/workplace of the presenter

Heart and Vascular Center, Semmelweis University

Authors

Dr Turschl Tímea Katalin¹, Dr Ladányi Zsuzsanna¹, Dr Fábián Alexandra¹, Dr Ferencz Andrea¹, Dr Tokodi Márton¹, Dr Nagy Andrea¹, Dr Apor Astrid¹, Prof Dr Zima Endre¹, Dr Straub Éva¹, Dr Ruppert Mihály¹, Dr Papp Roland¹, Dr Molnár Levente¹, Dr Kovács Attila¹, Dr Lakatos Bálint Károly¹, Prof Dr Merkely Béla¹

1: Heart and Vascular Center, Semmelweis University

Text of the abstract

Left ventricular (LV) functional assessment is a key element in the diagnosis of aortic stenosis (AS). Conventional echocardiographic parameters such as ejection fraction (EF) and global longitudinal strain (GLS) are heavily dependent on LV loading conditions. Myocardial work analysis may be a more accurate method of functional assessment in this pressure overload setting, however, pressure-strain analysis still neglects LV geometry and preload.
The aim of our study was to incorporate LV volume into myocardial work analysis and to test the prognostic value of pressure-volume-strain loop-derived myocardial work in patients undergoing transcatheter aortic valve replacement (TAVR).
316 patients (age: 79±6 years, 41% female) undergoing TAVR were enrolled. We performed detailed echocardiographic examinations and took non-invasive blood pressure measurements the day before the procedure. We measured EF and LV volumes throughout the entire cardiac cycle and speckle-tracking analysis was used to determine GLS values. Individual pressure curves were generated using the noninvasive blood pressure and the Doppler-derived mean transaortic gradient. Global constructive work (GCW) was calculated by utilizing strain rate and LV pressure curves. We further adjusted the pressure-strain to instantaneous LV volumes and therefore, we constructed pressure-strain-volume loops and quantified volume-adjusted GCW (GCWV). Our primary outcome was all-cause death, reached by 68 patients during a median follow-up of 25 months.
Using univariate Cox regression analysis, EF was not a significant predictor, however, GLS (HR: 1.083 [1.017-1.154], p=0.01), GCW per 100 unit change (HR: 0.951 ([0.907-0.997], p=0.04) and also GCWV per 10 unit change (HR: 0.935 [0.881-0.993], p=0.03) were significantly predictors of outcome. In a multivariable Cox regression model, GCWV emerged as a significant independent predictor (HR: 0.928 [0.870-0.991], p=0.03) along with age, sex, atrial fibrillation, diabetes mellitus and hemoglobin, while other LV functional parameters did not.
GCWV was an independent predictor of outcome in our cohort, while conventional measures and even conventional myocardial work was not. Integrating volume into the myocardial work analysis and pressure-volume-strain loop-derived measures may be sensitive markers of load-independent LV function.

Supported by the EKÖP-2024-227 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Reasearch, Development and Innovation fund and the SE 250+ grant of Semmelweis University (123943/DIDIT/2024).