Left ventricular active strain energy density is a promising new measure of systolic function

David H. MacIver, Peter Agger, Jonathan C.L. Rodrigues, Henggui Zhang

Research output: Contribution to journalArticlepeer-review


The left ventricular ejection fraction does not accurately predict exercise capacity or symptom severity and has a limited role in predicting prognosis in heart failure. A better method of assessing ventricular performance is needed to aid understanding of the pathophysiological mechanisms and guide management in conditions such as heart failure. In this study, we propose two novel measures to quantify myocardial performance, the global longitudinal active strain energy (GLASE) and its density (GLASED) and compare them to existing measures in normal and diseased left ventricles. GLASED calculates the work done per unit volume of muscle (energy density) by combining information from myocardial strain and wall stress (contractile force per unit cross sectional area). Magnetic resonance images were obtained from 183 individuals forming four cohorts (normal, hypertension, dilated cardiomyopathy, and cardiac amyloidosis). GLASE and GLASED were compared with the standard ejection fraction, the corrected ejection fraction, myocardial strains, stroke work and myocardial forces. Myocardial shortening was decreased in all disease cohorts. Longitudinal stress was normal in hypertension, increased in dilated cardiomyopathy and severely decreased in amyloid heart disease. GLASE was increased in hypertension. GLASED was mildly reduced in hypertension (1.39 ± 0.65 kJ/m3), moderately reduced in dilated cardiomyopathy (0.86 ± 0.45 kJ/m3) and severely reduced in amyloid heart disease (0.42 ± 0.28 kJ/m3) compared to the control cohort (1.94 ± 0.49 kJ/m3). GLASED progressively decreased in the hypertension, dilated cardiomyopathy and cardiac amyloid cohorts indicating that mechanical work done and systolic performance is severely reduced in cardiac amyloid despite the relatively preserved ejection fraction. GLASED provides a new technique for assessing left ventricular myocardial health and contractile function.

Original languageEnglish
Article number12717
JournalScientific Reports
Issue number1
Early online date26 Jul 2022
Publication statusPublished - 31 Dec 2022
Externally publishedYes

Bibliographical note

Funding Information:
The work in this study was funded by awards to H. Zhang from BHF (FS/PhD/20/29053) and EPSRC (United Kingdom) (EP/J00958X/1 and EP/I029826/1).

Funding Information:
We would like to thank the team at the Bristol Heart Institute, Nathan Manghat, Mark Hamilton, Angus Nightingale, Chiara Bucciarelli-Ducci for contributing their patients to this study. We would also like to thank Benjamin Rooms, Katie Hyde, Stephen Rohan for helping collate the MRI and demographic data. Finally, we would like to express our thanks to Dr John B. Partridge, Prof Robert H. Anderson, and Prof Paul P. Lunkenheimer for their critical review of the manuscript and helpful advice.

ASJC Scopus subject areas

  • General


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