Prognostic value of myocardial work indices measured on echocardiography in patients with aortic stenosis undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis

Abstract

Background & Objective: Myocardial work (MW) indices offer an afterload-adjusted assessment of left ventricular (LV) function and may improve risk stratification in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). This systematic review and meta-analysis aimed to evaluate the prognostic significance of MW indices, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), in patients with severe AS undergoing TAVR.

Methodology: PubMed, Embase, Web of Science, and Scopus were searched from inception to 26 November 2025 for studies assessing prognostic value of MW indices in TAVR-treated AS patients. Data were synthesised qualitatively, and a random-effects meta-analysis was performed when at least three studies reported comparable effect estimates.

Results: Five cohort studies met the inclusion criteria. Across studies, GWI consistently demonstrated strong prognostic performance. Lower post-TAVR GWI predicted mortality in multiple cohorts, with thresholds ranging from 1,095 to 1,234 mmHg% and area-under-the-curve values up to 0.71. Pooled analysis confirmed that higher GWI was associated with reduced mortality (HR 0.94; 95% CI 0.90–0.98). GCW showed modest prognostic value, whereas GWW was not independently predictive. GWE was a significant predictor in select studies, but mostly in univariate models.

Conclusion: Limited evidence shows that MW indices, especially GWI, may provide meaningful prognostic information in AS patients undergoing TAVR. Further studies are needed to improve the evidence.