Association between Myocardial Work Indices and Cardiovascular Events According to Hypertension in the General Population

Flemming Javier Olsen*, Kristoffer Grundtvig Skaarup, Mats Christian Højbjerg Lassen, Niklas Dyrby Johansen, Gorm Boje Jensen, Peter Schnohr, Jacob Louis Marott, Peter Søgaard, Gunnar Gislason, Jesper Hastrup Svendsen, Rasmus Møgelvang, John Moene Aalen, Otto Armin Smiseth, Espen Wattenberg Remme, Tor Biering-Sørensen

*Corresponding author for this work


AIMS: Pressure-strain loop (PSL) analysis is a novel echocardiographic tool capable of assessing myocardial work non-invasively. In this study, we aim to evaluate the prognostic value of myocardial work indices in the general population.

METHODS AND RESULTS: This was a prospective community-based cohort study (n = 4466). PSL analyses were performed to acquire global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency (GWE). The endpoint was a composite of heart failure or cardiovascular death (HF/CVD). Survival analysis was applied. A total of 3932 participants were included in this analysis (median age: 58 years, 43% men). Of these, 124 (3%) experienced the outcome during a median follow-up period of 3.5 years [interquartile range (IQR): 2.6-4.4 years]. Hypertension significantly modified the association between all work indices and outcome (P for interaction < 0.05), such that work indices posed a higher risk of outcome in non-hypertensive than in hypertensive participants. After adjusting for Atherosclerosis Risk in Communities (ARIC)-HF risk variables, all work indices predicted outcome in non-hypertensive participants, but only GWI, GCW, and GWE predicted outcome in hypertensive participants [GWI: hazard ratio (HR) = 1.12 (1.07-1.16), per 100 mmHg% decrease; GCW: HR = 1.12 (1.08-1.17), per 100 mmHg% decrease; GWE: HR = 1.08 (1.04-1.12), per 1% decrease]. Only GWE significantly increased C-statistics when added to ARIC-HF risk variables in hypertensive participants (C-stat 0.865 vs. 0.877, P for increment = 0.003).

CONCLUSION: Hypertension modifies the association between myocardial work indices and HF/CVD in the general population. All work indices are associated with outcome in normotensive participants. GWI, GCW, and GWE are independently associated with outcome in hypertension, but only GWE improves risk prediction.

Original languageEnglish
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number3
Pages (from-to)413-424
Number of pages12
Publication statusPublished - 22 Feb 2024


  • Atherosclerosis
  • Cohort Studies
  • Female
  • Heart Failure/diagnostic imaging
  • Humans
  • Hypertension/epidemiology
  • Male
  • Middle Aged
  • Myocardium
  • Prospective Studies
  • Stroke Volume
  • Ventricular Function, Left


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