Speckle tracking echocardiography for assessing left ventricular myocardial work and predicting prognosis in heart failure patients: a retrospective cohort study

Myocardial work (MW) is considered to reflect myocardial metabolism, yet its prognostic value in heart failure (HF) requires further validation. MW indices were explored for predicting major adverse cardiovascular events (MACE) in HF patients. This single-center retrospective study screened 269 patients with chronic HF at the Hospital from June 2023 to June 2025. After exclusion, 250 patients were analyzed and stratified into New York heart association (NYHA) Ⅱ-Ⅳ subgroups (72, 118 and 60 cases, respectively). Another 60 healthy physical examinees were enrolled as the control group. Observation indicators included left ventricular ejection fraction (LVEF), serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), global longitudinal strain (GLS), MW parameters global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE). Pearson correlation analyzed relationships between MW indices and clinical biomarkers. Cox regression identified independent risk factors for short‑term MACE, and receiver operating characteristic (ROC) curves assessed predictive efficacy. Compared with healthy controls, all HF subgroups presented reduced LVEF, absolute GLS, GWI, GCW and GWE, as well as increased NT-proBNP and GWW (all P < 0.001). With higher NYHA grade, cardiac systolic and MW indicators gradually declined, while NT-proBNP and GWW increased. LVEF, GLS and beneficial MW parameters were positively correlated with each other yet negatively correlated with NT-proBNP, whereas GWW showed opposite correlations (all P < 0.001). In the 6-month follow-up, the MACE incidence was 19.2%. Multivariate Cox regression revealed that NT-proBNP was an independent risk factor for MACE, while absolute GLS, GWI and GWE were independently associated with lower MACE risk (all P < 0.05). The combined GWI-GWE model yielded an area under the curve (AUC) of 0.862 (95%CI: 0.795–0.930), exhibiting superior predictive performance to single biomarkers (all P < 0.05). Speckle-tracking-derived MW reflects HF dysfunction. GWI and GWE independently predict adverse outcomes, with combined use demonstrating higher discriminative ability than single parameters.