Prognostic value of myocardial work in heart failure with reduced ejection fraction

Background

Heart failure with reduced ejection fraction remains associated with high mortality and rehospitalisation rates. Myocardial work has emerged as a novel echocardiographic parameter providing a comprehensive assessment of myocardial performance and may offer incremental prognostic value beyond conventional measures.

Purpose

This study aimed to evaluate the prognostic value of myocardial work for adverse cardiac outcomes in patients with heart failure and reduced ejection fraction.

Methods

In this prospective study, we enrolled 78 patients with heart failure and reduced ejection fraction between January 2025 and October 2025. Standard echocardiographic parameters and myocardial work indices were measured. Patients were followed for a composite outcome of all-cause mortality and unplanned heart failure hospitalisations.

Results

The mean age was 62±12 years with a sex-ratio of 4. Ischemic cardiomyopathy was the most common heart failure etiology (66%). Mean left ventrile ejection fraction (LVEF) was 29±8%. Mean global work index (GWI) was 718±359mmHg% and mean global work efficiency (GWE) was 79±7%.

Twenty-six (33%) patients reached the composite outcome with a mean time to event of 7 months (range 2-11 months).

On univariate analysis, GWI was significantly associated with the composite outcome (Hazard ratio [HR] 0.998, 95% confidence interval [CI] 0.997–0.999, p=0.04) while LVEF (HR 0.98, 95% CI 0.93–1.03, p=0.38) and GWE (HR 0.98, 95% CI 0.94–1.02, p=0.16) were not. On multivariate analysis, GWI remained independently associated with the composite outcome (p=0.03) after adjustment for LVEF.

Conclusion

Global work index is significantly associated with adverse cardiac outcomes in heart failure with reduced ejection fraction and may serve as a tool for risk stratification warranting validation in further studies.