LAUSR

Myocardial work (MW) is a new combined parameter that takes into account longitudinal strain (LS) and systolic pressure. The authors of this article currently published in Journal of Clinical Ultrasound 1 demonstrate that patients with bicuspid aortic valve (BAV) and normal left ventricular systolic function by conventional parameters (i.e., left ventricular ejection fraction (LVEF) and left ventricular (LV) strain) exhibit changes in MW-derived parameters in comparison with a control group. Specifically they found increase in global wasted work and concomitant decrease in global work efficiency, and these changes were associated to higher arterial stiffness, measured non-invasively by a tonometry system. Of note, even though traditionally measured blood pressure was similar in patients with BAV and controls, arterial tonometry, a validated index of aortic stiffness, showed differences between BAV patients and controls. Longitudinal strain is an easy to measure parameter that represents deformation of the myocardium, therefore it takes into account the change from a maximal to a minimal dimension and vice versa. To be effective, this deformation should correspond to the systolic period in the negative way (strain decreasing or improving); and to the isovolumic relaxation time (IVRT) period in the positive way (strain increasing during lengthening). One advantage of MW assessments is that the effectivity of strain can be properly measured by these work indexes. Thus, myocardial constructive work (MCW) is the sum of positive work (LS by systolic pressure) performed during shortening in systole and negative work during lengthening in