Noninvasive myocardial work in severe aortic regurgitation: implications for postoperative left ventricular dysfunction.

Aims: Noninvasive myocardial work offers a promising echocardiographic method to evaluate left ventricular (LV) function as it integrates myocardial deformation and afterload. The study sought to investigate the association of myocardial work indices with post-operative LV dysfunction in patients with chronic severe aortic regurgitation (AR).

Methods and results: Pre-operative LV ejection fraction (LVEF), LV global work index (LV GWI), LV global constructive work (LV GCW), LV global wasted work (LV GWW), and LV global work efficiency (LV GWE) were measured. Post-operative LV dysfunction was defined as LVEF < 50% at 12 months after surgery. One hundred and forty-one patients with chronic severe AR and preserved LVEF (52 (42-58) years; 74.5 % men) who underwent aortic valve surgery were studied. Twenty-six patients (18%) developed post-operative LV dysfunction. Patients with post-operative LV dysfunction had lower LV GWI, LV GCW, and LV GWE compared to those without (all P < 0.05). In multivariate analysis, LV GWI (adjusted odds ratio (OR): 0.99; 95% CI: 0.98-1.00; P < 0.001), and LV GCW (adjusted OR: 0.99; 95% CI: 0.99-1.00; P < 0.001) were associated with post-operative LV dysfunction. Moreover, a multivariate logistic regression model with LV GWI (Akaike information criterion = 108.023, Bayesian information criterion = 119.818, C-statistics = 0.836) showed the best capability in predicting post-operative LV dysfunction. The comparative analysis of C-statistics across the three models-LV GWI, LV GCW, and LV GLS-did not reveal statistically significant differences (all P > 0.05).

Conclusion: In patients with chronic severe AR and preserved LVEF, impaired myocardial work indices are associated with post-operative LV dysfunction. Myocardial work has potential value for risk stratification and surgical decision-making in such a population.