Left ventricular performance by work and wasted energy: is strain not sufficient?
Abstract
This editorial refers to ‘Novel insights into the athlete's heart: is myocardial work the new champion of systolic function?’ by M. Tokodi et al. pp. 188–197. Almost 60 years ago, Folse and Braunwald1 introduced left ventricular (LV) ejection fraction (EF) as a method to measure LV pump function. Since then, EF has been the most important measure of LV function in clinical practice. An important limitation of EF, however, is that about 50% of all heart failure patients have normal or near-normal EF, a condition named heart failure with preserved EF (HFpEF). After a couple of decades with negative drug trials in HFpEF, it was recently shown that the sodium–glucose co-transporter 2 inhibitor empagliflozin reduced the combined risk of cardiovascular death or hospitalization for heart failure in HFpEF.2 This therapeutic breakthrough holds strong promise for the future and gives motivation for developing new and more sensitive methods to identify HFpEF. In the 1980’s myocardial strain by cardiovascular magnetic resonance tagging was introduced as a research tool.3 In 1998, Heimdal et al.4 introduced myocardial strain rate by echocardiography as a clinical method to quantify LV function. Peak systolic myocardial strain is closely related to contractility but is somewhat limited by strong load dependency.5 In spite of that, LV global longitudinal strain (GLS) by speckle-tracking echocardiography has become an important diagnostic tool and may also be used in the evaluation of…
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