Moya Martín, Ana (2024) The role of Myocardial Work in clinical practice. [Tesi di dottorato]

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Abstract

This PhD thesis aims to investigate the potential role of myocardial work analysis in detecting subclinical heart failure as well as its prognostic value across various cardiac pathologies. Myocardial work is a sophisticated echocardiographic tool derived from pressure-strain loop analysis that allows a comprehensive assessment of cardiac performance. Its calculation relies on the acquisition of high-quality echocardiographic images for strain analysis and the integration of valve event timing and intraventricular pressure. In non-invasive myocardial work, the intraventricular pressure curve is estimated using the cuff measurement of the arterial blood pressure. The exceptional added value of myocardial work analysis consists of the combination of multiple complementary parameters, namely, myocardial work index, myocardial work efficiency, constructive work, and wasted work. The assessment of all parameters together allows a better understanding of the (patho-)physiology behind each cardiac condition and an enhanced evaluation of the cardiac function. To date, myocardial work has not been implemented in the daily clinical practice as its clinical benefit has not been demonstrated yet by large randomized controlled clinical trials. By contrast, highly promising results from smaller studies have been published in the last years, and there is increasing interest for this method as a pivotal research topic in non-invasive cardiac imaging. Nevertheless, a considerable lack of data and knowledge still prevents us from guiding clinical decisions based on myocardial work analysis. Additionally, its methodology requires a notable level of expertise from the sonographer as well as adequate software support. Learning to interpret myocardial work values and values’ changes in each cardiac condition is crucial for its implementation in daily practice. Therefore, this PhD thesis pursues to highlight the usefulness of myocardial work analysis in different clinical scenarios and to propose practical ways to implement this novel technique to guide clinical decisions and patient’s management. This PhD thesis consists of 5 chapters. The first chapter provides an overview of the state-of-the-art on myocardial work. Next to its principle, methodology and pitfalls, the chapter includes relevant studies and publications on the use of myocardial work in different cardiac pathologies previous to this work. The consecutive chapters focus each on a different cardiac condition and investigate the potential role of myocardial work analysis in that specific pathology: cardio-oncology (chapter 2), aortic valve stenosis (chapter 3), congenital heart disease (chapter 4) and cardiac amyloidosis (chapter 5). The chapters are followed by the discussion, conclusion and future perspectives. Additionally, the appendix includes smaller analysis from which the results seamless align with the findings and conclusions of the different chapters. At last, the reader can find the author’s curriculum vitae and list of publications endorsed. This PhD thesis ends by acknowledging the contribution of many people whose dedication and support made this work possible.

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