Left ventricular myocardial work assessment demonstrates distinct patterns across aortic stenosis, chronic kidney disease, and cardiac amyloidosis despite all three conditions sharing increased LV wall thickness, supporting its complementary role in comprehensive evaluation of LV function and myocardial dysfunction.
Key Findings
Results
LV mass was significantly increased in all three disease groups compared with controls.
Three disease groups studied: severe aortic stenosis (AS), chronic kidney disease (CKD) on maintenance hemodialysis, and light-chain cardiac amyloidosis (CA)
Each group included 25 consecutive patients, with an additional 25 apparently healthy individuals serving as controls
All three conditions share increased LV wall thickness but arise from fundamentally different pathophysiological mechanisms
LV mass increase was confirmed across AS, CKD, and CA groups relative to controls
Results
LV ejection fraction was mildly reduced but similar across all three disease groups.
LVEF was mildly reduced in AS, CKD, and CA patient groups
No significant difference in LVEF was observed between the three disease groups
Similar LVEF values across groups highlight the need for additional tools beyond LVEF to differentiate myocardial dysfunction
This finding underscores the limitation of LVEF as a discriminating parameter among these conditions
Results
LV global longitudinal strain (GLS) was impaired in all patient groups, with the greatest reduction observed in cardiac amyloidosis.
GLS was quantified using speckle tracking echocardiography in all study participants
Cardiac amyloidosis showed the most severely impaired GLS among the three disease groups
GLS impairment was present in AS and CKD groups as well, though less severe than in CA
These findings reflect differential degrees of myocardial deformation across pathophysiologically distinct conditions
Results
Global work index (GWI) and global constructive work (GCW) were highest in AS patients and lowest in CA patients, with CKD showing intermediate values.
GWI in AS: 1815 mmHg% (IQR 1271, 2061); GWI in CA: 804 mmHg% (IQR 596, 1091)
GCW in AS: 2094 mmHg% (IQR 1815, 2521); GCW in CA: 1117 mmHg% (IQR 810, 1256)
CKD patients demonstrated intermediate values for both GWI and GCW between AS and CA groups
Myocardial work was assessed as a relatively load-independent measure of LV myocardial contractile function
These distinct MW patterns were observed despite similar LVEF across all three disease groups
Results
Multivariable analyses confirmed distinct myocardial work patterns across the three disease groups after adjusting for demographic and hemodynamic variables.
Multivariable analyses adjusted for demographic and hemodynamic variables
The distinct patterns of GWI and GCW across AS, CKD, and CA were confirmed after adjustment
This supports that differences in myocardial work are not merely attributable to differences in loading conditions or patient demographics
Findings support MW assessment as complementary to standard echocardiographic parameters
Conclusions
LV myocardial work assessment demonstrates distinct patterns across conditions associated with increased LV wall thickness, supporting its complementary role in comprehensive LV function evaluation.
MW assessment is described as a 'novel non-invasive tool for relatively load-independent assessment of LV myocardial contractile function'
The study highlights that conditions sharing increased LV wall thickness (AS, CKD, CA) have fundamentally different pathophysiological mechanisms reflected in MW parameters
Authors conclude that larger prospective studies are required to establish diagnostic and prognostic utility of MW assessment
MW assessment differentiated between disease groups even when LVEF was similar, demonstrating added diagnostic value
What This Means
This research suggests that a newer ultrasound-based heart measurement technique, called myocardial work assessment, can distinguish between three different heart conditions that all cause the heart wall to become thickened — aortic stenosis (a narrowed heart valve), chronic kidney disease, and cardiac amyloidosis (a protein deposit disease). Despite all three conditions causing similar degrees of thickening and only mildly reduced pumping function (ejection fraction), the myocardial work measurements were strikingly different: patients with aortic stenosis had the highest values, cardiac amyloidosis patients had the lowest, and kidney disease patients fell in between. Standard measures like ejection fraction were unable to distinguish between these groups.
This matters because knowing which disease is causing heart wall thickening is critical for choosing the right treatment, and current standard tests can sometimes be insufficient to make that distinction. Myocardial work assessment — which accounts for blood pressure conditions during the heart's squeeze cycle — appears to capture differences in how effectively the heart muscle is actually contracting, not just how much blood it pumps out. The cardiac amyloidosis patients showed the most severely impaired muscle function by multiple measures, consistent with what is known about that disease's damaging effects on heart muscle fibers.
This research suggests that adding myocardial work measurements to routine heart ultrasound evaluations could improve doctors' ability to characterize the type and severity of heart muscle dysfunction in patients with thickened heart walls. The study was relatively small (25 patients per group), and the authors themselves call for larger prospective studies to determine whether these measurements can reliably predict patient outcomes or guide treatment decisions.
Nagvanshi S, Kasliwal R, Bansal M. (2026). Non-Invasive Assessment of Left Ventricular Myocardial Work in Conditions Associated With Increased Left Ventricular Wall Thickness.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70604