Graphical abstract representing myocardial work and pressure-strain loops in cardiac imaging.

Decoding Heart Health: A New Approach to Understanding Myocardial Function

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"Discover how non-invasive techniques are revolutionizing the assessment of heart muscle performance in hypertension and cardiomyopathy."

For years, doctors have relied on ejection fraction (EF) to gauge how well your heart is pumping. But EF has limitations, especially since it doesn't always catch subtle problems that can lead to major cardiac events. Enter 2D speckle-tracking echocardiography (STE), a more advanced imaging technique that allows for a more detailed look at heart function.

However, even STE isn't perfect. One major issue is that strain imaging, which STE uses, is affected by how much pressure the heart is under—a concept known as load dependency. High blood pressure, for example, can make it seem like the heart isn't working as well as it actually is. This is where myocardial work (MW) comes in; it’s a new way to measure heart function that accounts for both deformation and afterload.

A recent study published in the European Heart Journal - Cardiovascular Imaging explores a novel, non-invasive approach to assessing myocardial work by analyzing left ventricular pressure-strain relations in patients with hypertension and dilated cardiomyopathy. This method may help health professional understand the relationship between LV remodeling and increased wall stress under different loading conditions.

What is Myocardial Work?

Graphical abstract representing myocardial work and pressure-strain loops in cardiac imaging.

Myocardial work (MW) is a method to quantify the performance of the heart muscle by combining measurements of myocardial deformation and left ventricular (LV) pressure. Unlike conventional methods that primarily focus on ejection fraction or global longitudinal strain (GLS), MW integrates LV pressure to provide a comprehensive assessment of heart function.

This non-invasive approach uses pressure-strain loops (PSL) to graphically represent the heart’s performance throughout the cardiac cycle. By calculating the area within these loops, clinicians can derive several key metrics:

Global Work Index (GWI): Represents the total work performed by the heart.
Constructive Work (GCW): Indicates the work contributing to LV ejection during systole.
Wasted Work (GWW): Represents the work that does not contribute to LV ejection.
Myocardial Work Efficiency (GWE): Calculated as the ratio of constructive work to the sum of constructive and wasted work, providing a measure of how efficiently the heart is working.

By incorporating both deformation and LV pressure, myocardial work may provide incremental value to myocardial function assessment, allowing a more nuanced understanding of heart performance under varying conditions.

The Future of Heart Health Assessment

Myocardial work offers a promising new avenue for understanding heart function, especially in conditions like hypertension and cardiomyopathy. By accounting for both myocardial deformation and LV pressure, this technique provides a more complete picture of cardiac performance. As research continues and technology advances, MW may become a routine part of cardiac assessments, helping doctors to better diagnose and manage heart disease.

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Everything You Need To Know

What is Myocardial Work (MW), and how does it differ from Ejection Fraction (EF)?

Myocardial Work (MW) is a method used to quantify the performance of the heart muscle, combining measurements of myocardial deformation and left ventricular (LV) pressure. Unlike Ejection Fraction (EF), which primarily focuses on the percentage of blood pumped out of the left ventricle with each heartbeat, MW provides a more comprehensive assessment of heart function. MW incorporates both deformation and LV pressure, which allows for a more nuanced understanding of heart performance under varying conditions, especially in cases of hypertension and cardiomyopathy, where the heart's ability to function is affected by pressure and the heart's ability to contract efficiently. This is achieved through the use of pressure-strain loops (PSL), which graphically represent the heart’s performance throughout the cardiac cycle.

How does 2D speckle-tracking echocardiography (STE) contribute to the understanding of heart function, and what are its limitations?

2D speckle-tracking echocardiography (STE) is a more advanced imaging technique that allows for a more detailed look at heart function compared to traditional methods. STE analyzes the movement of the heart muscle, providing insights into myocardial deformation, specifically through strain imaging. However, STE has limitations. One significant issue is that strain imaging is affected by load dependency, meaning the measurements can be influenced by the pressure the heart is under (afterload). For example, high blood pressure can make it seem like the heart isn't working as well as it actually is, potentially leading to misdiagnosis or inaccurate assessment.

What are pressure-strain loops (PSL), and how are they used to assess Myocardial Work (MW)?

Pressure-strain loops (PSL) are graphical representations of the heart's performance throughout the cardiac cycle. They are central to the assessment of Myocardial Work (MW). PSL integrate measurements of myocardial deformation and left ventricular (LV) pressure. By analyzing the area within these loops, clinicians can derive key metrics such as Global Work Index (GWI), Constructive Work (GCW), Wasted Work (GWW), and Myocardial Work Efficiency (GWE). This allows for a detailed and comprehensive assessment of the heart's function, providing insights into how efficiently the heart is working and identifying any inefficiencies that may be present. PSL enables a more precise evaluation of heart performance, especially in conditions like hypertension and cardiomyopathy.

Can you explain the different metrics derived from Myocardial Work (MW) using pressure-strain loops (PSL), such as GWI, GCW, GWW, and GWE?

Myocardial Work (MW) assessment, utilizing pressure-strain loops (PSL), provides several key metrics to evaluate heart function. * **Global Work Index (GWI):** Represents the total work performed by the heart during a cardiac cycle. * **Constructive Work (GCW):** Indicates the portion of work that contributes to LV ejection during systole (the contraction phase). * **Wasted Work (GWW):** Represents the portion of work that does not contribute to LV ejection, indicating inefficiency in the heart's performance. * **Myocardial Work Efficiency (GWE):** Calculated as the ratio of Constructive Work (GCW) to the sum of Constructive Work (GCW) and Wasted Work (GWW). This metric provides a measure of how efficiently the heart is working. These metrics offer a comprehensive view of the heart's performance, helping clinicians assess the efficiency and effectiveness of myocardial function in various conditions such as hypertension and cardiomyopathy.

How could the use of Myocardial Work (MW) improve the diagnosis and management of heart diseases like hypertension and cardiomyopathy?

Myocardial Work (MW) offers a promising new approach to understanding heart function, especially in conditions like hypertension and cardiomyopathy. By accounting for both myocardial deformation and left ventricular (LV) pressure, MW provides a more complete picture of cardiac performance. MW's ability to incorporate both deformation and LV pressure provides a more nuanced understanding of heart performance under varying conditions, which enables a more precise evaluation of heart performance. This can lead to earlier and more accurate diagnoses, potentially preventing major cardiac events. Furthermore, by providing detailed metrics like GWI, GCW, GWW, and GWE, clinicians can better monitor the effects of treatments and tailor interventions to improve heart efficiency. The potential to better understand the relationship between LV remodeling and increased wall stress may also lead to the development of more effective treatment strategies, ultimately improving patient outcomes in the management of heart diseases.