The use of noninvasive parameters of myocardial work in the diagnosis of cardiac insufficiency with preserved ejection fraction in the postinfarction period

Objective. To evaluate noninvasive parameters of myocardial work in patients with preserved left ventricular ejection fraction (LVEF) 6 months after myocardial infarction (MI), depending on the presence/absence of heart failure (HF) using the HFA-PEFF algorithm (the Heart Failure Association Score for heart failure with preserved ejection fraction). Materials and methods. We included 90 patients who had suffered MI 24 weeks before screening and had LVEF ≥ 50 % at the time of inclusion. The average age of the subjects was 58 (53; 61) years. Echocardiography was performed using Vivid E95 GE Healthcare device (USA). The global longitudinal strain (GLS), global work index (GWI), global constructive (GCW) and wasted work (GWW), and global work efficiency (GWE) were evaluated. Following the HFA-PEFF algorithm, the score was calculated: < 2 points indicated that the diagnosis of HFpEF could be excluded, in case of ≥ 5 points the diagnosis was considered confirmed, and 2–4 points indicated an uncertain result. Results. The 1^st group with a low probability of HFpEF included 17 (19 %) people; the 2^nd group — 47 (52 %) subjects with intermediate probability of HFpEF; the 3^rd group included 26 (29 %) people with highly probable/confirmed HFpEF (≥ 5 points). Lower values of GWE, GCW, and GWI were found after 6 months in patients with confirmed HFpEF compared with group 1. Dynamic follow-up showed improvement in GWI within 6 months due to an increase in GCW in patients in the group with unlikely HFpEF. GWI, GCW and GWE had high sensitivity for the detection of highly probable/confirmed HFpEF. The threshold value for GWE was 93,5 % (sensitivity 90 %; specificity 70 %, NPV 85 %), for GWI — 1420 mmHg % (sensitivity 90 %; specificity 80 %, NPV 88 %), and for GCW — 1777 mmHg % (sensitivity 85 %; specificity 70 %, NPV 84 %). Conclusion. The parameters of the myocardial work have diagnostic significance in relation to the exclusion of HFpEF in patients who have suffered MI.

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