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Venet M, Baranger J, Malik A, Nguyen MB, Mital S, Friedberg MK, Pernot M, Papadacci C, Salles S, Chaturvedi R, Mertens L, Villemain O. Towards non-invasive assessment of myocardial work using myocardial stiffness and strain: a human pilot study. Eur Heart J Cardiovasc Imaging 2025; 26:1051-1064. [PMID: 40085822 PMCID: PMC12123516 DOI: 10.1093/ehjci/jeaf089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 11/18/2024] [Accepted: 03/05/2025] [Indexed: 03/16/2025] Open
Abstract
AIMS Myocardial work assessment has emerged as a promising tool for left ventricular (LV) performance evaluation. Existing non-invasive methods for assessing it rely on assumptions on LV pressure and geometry. Recently, shear wave elastography allowed to quantify changes in myocardial stiffness throughout the cardiac cycle. Based on Hooke's law, it becomes theoretically possible to calculate myocardial stress and work from myocardial stiffness and strain measurements. The main objective of this study is to demonstrate the feasibility of this comprehensive ultrasound approach and to compare myocardial work values between populations where variations are anticipated. METHODS AND RESULTS Children with hypertrophic cardiomyopathy (HCM), aortic stenosis (AS) and healthy volunteers (HV) were included in this study. Segment dimensions, strain, thickness, and segmental myocardial stiffness were assessed in the basal antero-septal segment throughout the cardiac cycle. One-beat segmental work, the stress-strain loop area, and contributive and dissipative work were compared between groups. Twenty HV (9.8 ± 5.3 years of age), 20 HCM (10.0 ± 6.1 years of age), and 5 AS (5.3 ± 4.3 years of age) subjects were included. One-beat segmental work was significantly higher in AS (272.0 ± 102.9 µJ/mm) and lower in HCM (38.2 ± 106.9 µJ/mm) compared with HV (131.1 ± 83.3 µJ/mm), P = 0.02 and P = 0.01, respectively. Desynchronized work was prevailing in HCM with dissipative work during systole measured at 17.3 ± 28.9 µJ/mm and contributive work during diastole measured at 15.3 ± 18.0 µJ/mm. The stress-strain loop area was higher in AS (95.2 ± 31.1 kPa%) and HV (66.2 ± 35.9 kPa%) than in HCM (5.8 ± 13.0 kPa%), P < 0.01. CONCLUSION Calculating segmental myocardial work based on myocardial stiffness and strain measurements is technically feasible. This approach overcomes the inherent limitations of current methods by introducing a direct quantitative measure of myocardial stress.
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Affiliation(s)
- Maelys Venet
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth St, University of Toronto, Toronto, ON M5G 1E8, Ontario, Canada
- Ted Rogers Centre for Heart Research, 170 Elizabeth St, Toronto, ON M5G 1E8, Canada
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), 1 avenue Magellan - 33600 Pessac, France
- Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Av. du Haut Lévêque, 33600 Pessac, France
| | - Jerome Baranger
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth St, University of Toronto, Toronto, ON M5G 1E8, Ontario, Canada
- Ted Rogers Centre for Heart Research, 170 Elizabeth St, Toronto, ON M5G 1E8, Canada
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE, PSL Research University, Paris, France
| | - Aimen Malik
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth St, University of Toronto, Toronto, ON M5G 1E8, Ontario, Canada
- Ted Rogers Centre for Heart Research, 170 Elizabeth St, Toronto, ON M5G 1E8, Canada
| | - Minh B Nguyen
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth St, University of Toronto, Toronto, ON M5G 1E8, Ontario, Canada
- Ted Rogers Centre for Heart Research, 170 Elizabeth St, Toronto, ON M5G 1E8, Canada
- Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Seema Mital
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth St, University of Toronto, Toronto, ON M5G 1E8, Ontario, Canada
- Ted Rogers Centre for Heart Research, 170 Elizabeth St, Toronto, ON M5G 1E8, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mark K Friedberg
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth St, University of Toronto, Toronto, ON M5G 1E8, Ontario, Canada
- Ted Rogers Centre for Heart Research, 170 Elizabeth St, Toronto, ON M5G 1E8, Canada
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE, PSL Research University, Paris, France
| | - Clement Papadacci
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE, PSL Research University, Paris, France
| | - Sebastien Salles
- Laboratoire d’Imagerie Biomédicale (LIB), CNRS, INSERM, Sorbonne Université, Paris, France
| | - Rajiv Chaturvedi
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth St, University of Toronto, Toronto, ON M5G 1E8, Ontario, Canada
- Ted Rogers Centre for Heart Research, 170 Elizabeth St, Toronto, ON M5G 1E8, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth St, University of Toronto, Toronto, ON M5G 1E8, Ontario, Canada
- Ted Rogers Centre for Heart Research, 170 Elizabeth St, Toronto, ON M5G 1E8, Canada
| | - Olivier Villemain
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth St, University of Toronto, Toronto, ON M5G 1E8, Ontario, Canada
- Ted Rogers Centre for Heart Research, 170 Elizabeth St, Toronto, ON M5G 1E8, Canada
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), 1 avenue Magellan - 33600 Pessac, France
- Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Av. du Haut Lévêque, 33600 Pessac, France
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