Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis

Background The estimation of myocardial work by pressure strain loops ( PSL s) is a totally new non‐invasive approach to assess myocardial performance, and its role in patients with hypertrophic cardiomyopathy is unknown. The aims of the present study are therefore: (a) to compare myocardial work in patients with non‐obstructive hypertrophic cardiomyopathy ( HCM ) and in a subset of age‐matched healthy controls and (b) to assess the correlation between myocardial work and left ventricular (LV) fibrosis. Design Eighty‐two patients with non‐obstructive HCM (58 ± 14 years) and 20 age‐matched healthy subjects (58 ± 7 years, P  = 0.99) underwent standard and speckle‐tracking echocardiography to assess myocardial dimensions and deformation parameters. PSL s analysis was used to estimate global myocardial constructive work ( GCW ) and wasted work ( GWW ). LV fibrosis was estimated at cardiac magnetic resonance ( CMR ) by qualitative assessment of late gadolinium enhancement ( LGE ), and significant fibrosis was defined as LGE in ≥2 LV segments. Results Global constructive work (1599 ± 423 vs 2248 ± 249 mm Hg%, P  < 0.0001) was significantly reduced in HCM compared to the control group. No difference was observed in GWW (141 ± 125 vs 101 ± 88 mm Hg%, P  = 0.18) and LV ejection fraction (LVEF) (63 ± 13 vs 66 ± 4% P  = 0.17) between the two groups. In HCM , GCW was the only predictor of LV fibrosis at multivariable analysis ( OR 1.01, 95% CI : 0.99–1.08, P  = 0.04). A cutoff value of 1623 mm Hg% ( AUC 0.80, 95% CI : 0.66–0.93, P  < 0.0001) was able to predict myocardial fibrosis with a good sensitivity and fair specificity (82% and 67%, respectively). Conclusions Global constructive work is significantly reduced in HCM despite normal LVEF and is associated with the LV fibrosis as assessed by LGE .