Analysis of myocardial work indexes and two-dimensional longitudinal strain by echocardiography in patients with endomyocardial fibrosis

Abstract Introduction Endomyocardial Fibrosis (EMF) is a restrictive cardiomyopathy of unknown etiology and poor prognosis, with higher prevalence in underdeveloped countries. It is characterized by deposits of fibrous tissue in the subendocardium and the underlying myocardium. Transthoracic echocardiography (TTE) is an important method for the diagnostic and prognostic evaluation of EMF. However, there are no studies concerning TTE with Global Longitudinal Strain (GLS) or myocardial work (MW) analysis by Speckle Tracking technique (STE) in patients with EMF. Purpose To analyze cardiac mechanics through biventricular GLS and left ventricular (LV) MW using STE in patients with EMF. Hypothesis: The analysis of cardiac mechanics through MW in patients with EMF can yield knowledge about cardiac physiology in patients with EMF. Methods Patients older than 18 years with a diagnosis of EMF underwent conventional TTE for morphological and functional cardiac analysis, as well as subsequent evaluation of biventricular GLS and LV MW by STE. Results Twenty-five patients with EMF were evaluated; demographic and echocardiographic parameters are detailed in Table 1. The average LV GLS was reduced (13.9 ± 1.6%) despite preserved LV ejection fraction (EF) by Simpson's method (57.3 ± 3.6%). Global work index (GWI: 1306 ± 250 mmHg%), global constructive work (GCW: 1730 ± 253 mmHg%), and global work efficiency (GWE: 84.2 ± 3.6 mmHg%) values were reduced, along with an increase in global wasted work (GWW: 282 ± 50 mmHg%). Regarding the right ventricular GLS, there was a reduction in global (16.8 ± 2.1%) and free wall values (18.7 ± 2.9%). These results show early systolic biventricular dysfunction, despite preserved LVEF, and reduction myocardial efficiency and increased wasted work, providing physiological bases for the underlying mechanisms of heart failure with preserved ejection fraction in patients with EMF. Conclusion Advanced methods of cardiac mechanics analysis, such as myocardial work and GLS by STE, are promising tools for the follow-up of patients with EMF, potentially serving as viable alternatives to predict early myocardial dysfunction.