Impact of cardiovascular risk factors on myocardial work-insights from the STAAB cohort study

Floran Sahiti, Caroline Morbach, Vladimir Cejka, Theresa Tiffe, Martin Wagner, Felizitas A Eichner, Götz Gelbrich, Peter U Heuschmann, Stefan Störk, Floran Sahiti, Caroline Morbach, Vladimir Cejka, Theresa Tiffe, Martin Wagner, Felizitas A Eichner, Götz Gelbrich, Peter U Heuschmann, Stefan Störk

Abstract

Myocardial work is a new echocardiography-based diagnostic tool, which allows to quantify left ventricular performance based on pressure-strain loops, and has been validated against invasively derived pressure-volume measurements. Myocardial work is described by its components (global constructive work [GCW], global wasted work [GWW]) and indices (global work index [GWI], global work efficiency [GWE]). Applying this innovative concept, we characterized the prevalence and severity of subclinical left ventricular compromise in the general population and estimated its association with cardiovascular (CV) risk factors. Within the Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study we comprehensively phenotyped a representative sample of the population of Würzburg, Germany, aged 30-79 years. Indices of myocardial work were determined in 1929 individuals (49.3% female, mean age 54 ± 12 years). In multivariable analysis, hypertension was associated with a mild increase in GCW, but a profound increase in GWW, resulting in higher GWI and lower GWE. All other CV risk factors were associated with lower GCW and GWI, but not with GWW. The association of hypertension and obesity with GWI was stronger in women. We conclude that traditional CV risk factors impact selectively and gender-specifically on left ventricular myocardial performance, independent of systolic blood pressure. Quantifying active systolic and diastolic compromise by derivation of myocardial work advances our understanding of pathophysiological processes in health and cardiac disease.

Conflict of interest statement

Floran Sahiti receives financial support from Interdisciplinary Center for Clinical Research (IZKF) Würzburg (MD/PhD program scholarship). Caroline Morbach reports a research cooperation with the University of Würzburg and Tomtec Imaging Systems funded by a research grant from the Bavarian Ministry of Economic Affairs, Regional Development and Energy, Germany, speakers honorarium from Amgen and Tomtec, a travel grant from Orion Pharma and Alnylam, participation in Advisory and Patient Eligibility Boards sponsored by AKCEA, Alnylam, Pfizer and EBR Systems outside the submitted work. Vladimir Cejka none. Theresa Tiffe none. Martin Wagner none. Felizitas Eichner none. Götz Gelbrich reports a research cooperation with the University Hospital Würzburg and TomTec Imaging Systems funded by a research grant from the Bavarian Ministry of Economic Affairs, Regional Development and Energy, Germany, a grant from the German Research Council (DFG) as the senior biometrician of the FIND-AF II trial outside the submitted work. Peter Heuschmann reports research grants from German Ministry of Research and Education, European Union, Charité—Universitätsmedizin Berlin, Berlin Chamber of Physicians, German Parkinson Society, University Hospital Würzburg, Robert Koch Institute, German Heart Foundation, Federal Joint Committee (G-BA) within the Innovationfond, University Hospital Heidelberg (within RASUNOA-prime; RASUNOA-prime is supported by an unrestricted research grant to the University Hospital Heidelberg from Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo), grants from Charité—Universitätsmedizin Berlin (within Mondafis; Mondafis is supported by an unrestricted research grant to the Charité from Bayer), from University Göttingen (within FIND-AF randomized; FIND-AF randomized is supported by an unrestricted research grant to the University Göttingen from Boehringer-Ingelheim), outside the submitted work. Stefan Störk reports research grants from the German Ministry of Education and Research, European Union, University Hospital Würzburg; participation in Advisory Boards for Astra-Zeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Novartis, Pfizer, Thermo-Fisher; principal investigator in trials (co-) sponsored by Bayer, Boehringer-Ingelheim, Novartis, Pfizer; speaker honoraria by Astra-Zeneca, Bayer, Boehringer Ingelheim, Novartis, Pfizer, Servier, outside the submitted work

© 2021. The Author(s).

Figures

Fig. 1. Surrogate measures of left ventricular…
Fig. 1. Surrogate measures of left ventricular function in relation to the cardiac cycle and ATP consumption.
Myocardial work includes total active myocardial work and allows us to differentiate constructive from wasted work components. LVEF left ventricular ejection fraction, GLPS global longitudinal peak strain, MyW myocardial work, GCW global constructive work, GWW global wasted work, MVC mitral valve closure, AVO aortic valve opening, AVC aortic valve closure, MVO mitral valve opening, IVRT isovolumic relaxation time, IVCT isovolumic contraction time, ATP adenosine triphosphate.

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