Subclinical Myocardial Impairment Tracking the Comorbidity Burden: A Layer-Specific Strain and Myocardial Work Analysis in Patients With Preserved Ejection Fraction
Echocardiography, cilt.43, sa.5, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 43 Sayı: 5
- Basım Tarihi: 2026
- Doi Numarası: 10.1111/echo.70498
- Dergi Adı: Echocardiography
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO)
- Anahtar Kelimeler: Charlson Comorbidity Index, HFpEF, layer-specific strain, myocardial work, subclinical dysfunction
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: The Charlson Comorbidity Index (CCI) is a validated mortality predictor in heart failure, but its utility in tracking subclinical left ventricular (LV) mechanics remains unclear. We evaluated the relationship between cumulative comorbidity burden, assessed by a modified CCI (mCCI), and LV mechanics using layer-specific speckle tracking echocardiography and non-invasive myocardial work (MW) analysis. Methods: Seventy-one stable outpatients with preserved LVEF (≥50%) and no overt heart failure or significant coronary artery disease were stratified by mCCI scores (adapted by excluding CAD and including hypertension): Group 1 (Low, 0–1), Group 2 (Intermediate, 2–3), Group 3 (High, ≥4). All underwent comprehensive echocardiography, layer-specific strain, and pressure-strain loop-derived MW analysis. Results: While LVEF and epicardial GLS (Epi-GLS) were preserved across groups, Group 3 showed significantly impaired endocardial GLS (Endo-GLS) versus Group 1 (−19.7 ± 2.9% vs. −22.4 ± 2.0%, p = 0.003), with a stepwise decrease in the transmural strain gradient (Endo/Epi ratio; p < 0.001). Global Wasted Work (GWW) (p = 0.006) and Peak Systolic Dispersion (PSD) (p = 0.002) increased progressively, while Global Work Efficiency (GWE) was reduced in the high-risk group. On multivariate regression, mCCI independently predicted Endo-GLS (β = 0.236, p = 0.021) and was the sole independent predictor of GWE (β = −0.394, p = 0.002), irrespective of age and systolic blood pressure. During a median 6-month follow-up, Group 3 had a higher composite event rate than Groups 1 and 2 (44.4% vs. 7.4% and 11.1%; log-rank p = 0.001). Conclusion: An increased comorbidity burden, assessed by the mCCI, is independently associated with subclinical myocardial dysfunction—selective subendocardial impairment, increased wasted work, and mechanical inefficiency—suggesting the mCCI may flag early mechanical uncoupling in preserved LVEF. Although these abnormalities correlated with adverse outcomes, their modest discriminative value (AUC 0.60–0.62) underscores the hypothesis-generating nature of these findings, warranting validation in larger prospective cohorts.