Value of myocardial work for assessment of myocardial adaptation to increased afterload in patients with high blood pressure at peak exercise

Mohamad Jihad Mansour, Wael AlJaroudi, Layal Mansour, Amal Nehme, Omar Hamoui, Wadih Ayoub, Elie Chammas

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Non-invasive myocardial work (MW) indices are superior to global longitudinal strain (GLS) to assess left ventricular (LV) mechanics in situations where afterload is abnormally high. The rotational motion of the apex provides an accurate index of LV contractility. To date, there are no data about MW values during stress echocardiography (SE), particularly for the apex. Our study aims at assessing MW indices at peak exercise to better understand LV mechanics in patients with high peak systolic blood pressure (SBP). A total of 81 patients without structural or ischemic heart disease referred for SE between January and June 2019 were included. BP measurements, GLS and MW indices were performed at rest and peak exercise. In order to quantify the role of the apex, apical work fraction (AWF) was also calculated and further stratified by peak SBP. A peak SBP > 180 mmHg was considered abnormally high. There were 36 (44%) patients who had peak SBP > 180 mmHg. They showed similar resting GLS and MW values when compared to control. However, peak stress global work index, constructive work and wasted work (GWW) increased significantly (P-value < 0.05), with a relatively constant global work efficiency. In the multivariate analysis, peak SBP > 180 mmHg was associated with threefold increased odds of abnormal peak GWW > 96.5 mmHg% (median value) (odds ratio 3.0, P-value 0.003). Apical work increased significantly when stratified by peak SBP (P-value 0.003) and AWF increased from 33 ± 3% to 37 ± 3% (rest-stress), P-value < 0.0001, but remained constant when stratified by peak SBP. Our analysis provides new data on MW indices at peak stress, particularly for patients with abnormal peak SBP response, and supports the role and the contribution of the apex to MW.

Original languageEnglish (US)
Pages (from-to)1647-1656
Number of pages10
JournalInternational Journal of Cardiovascular Imaging
Issue number9
StatePublished - Sep 1 2020
Externally publishedYes


  • Blood pressure
  • Global longitudinal strain
  • Left ventricular function
  • Myocardial work
  • Speckle tracking echocardiography
  • Stress echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Value of myocardial work for assessment of myocardial adaptation to increased afterload in patients with high blood pressure at peak exercise'. Together they form a unique fingerprint.

Cite this