{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T20:21:08Z","timestamp":1787602868859,"version":"build-2736575974"},"reference-count":54,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Non\u2010invasive myocardial work (MW) indices derived from pressure\u2010strain loop analysis, including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), have emerged as novel predictors of clinical outcomes across a broad spectrum of cardiac diseases. The purpose of this systematic review and meta\u2010analysis was to comprehensively synthesize published evidence examining the prognostic value of MW indices for predicting clinical outcomes and their diagnostic performance for identifying disease\u2010specific abnormalities across cardiac conditions, including heart failure, acute coronary syndrome, valvular heart disease, cardiomyopathy, cardiotoxicity in oncology, and cardiac resynchronization therapy response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science (up to May 2026) identified 24 eligible studies encompassing 4,710 participants. Random\u2010effects inverse\u2010variance models with restricted maximum likelihood (REML) estimation and Hartung\u2010Knapp confidence interval correction were applied. Direction\u2010harmonized hazard ratios (HR), odds ratios (OR), and standardized odds ratios (sOR) were pooled as an exploratory summary of ratio\u2010based effects, such that values exceeding 1.0 consistently indicated higher clinical risk with an adverse MW profile, while the HR\u2010only model was retained as the principal prognostic sensitivity analysis. Quality was assessed using the Newcastle\u2010Ottawa Scale and the GRADE framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The primary pooled analysis yielded a random\u2010effects estimate of 1.12 (95% CI: 0.99\u20131.27); however, substantial heterogeneity was observed (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 82.1%), reflecting important differences across cardiac disease populations. The all\u2010estimates sensitivity analysis (18 estimates;\n                      <jats:italic>n<\/jats:italic>\n                      = 3,536) achieved statistical significance (RE: 1.19; 95% CI: 1.04\u20131.35). The HR\u2010only sensitivity analysis yielded a similar effect estimate (RE: 1.18; 95% CI: 0.99\u20131.41) and represented the most clinically interpretable prognostic analysis. Disease\u2010specific analyses demonstrated heterogeneous effect sizes: the cardiomyopathy subgroup showed the largest associations (HR up to 5.46 for GWI in dilated cardiomyopathy), while heart failure and valvular disease demonstrated consistent moderate associations. Prognostic analyses primarily evaluated mortality, MACE, hospitalization, and other time\u2010to\u2010event outcomes, whereas diagnostic analyses assessed the ability of MW indices to identify disease\u2010specific abnormalities such as CTRCD and impaired microvascular perfusion. GCW demonstrated the highest diagnostic accuracy for cardiotoxicity detection (AUC: 0.97), substantially superior to global longitudinal strain (AUC: 0.73) in the same study population. GRADE certainty was moderate for advanced heart failure and asymptomatic aortic stenosis, and low to very low for other disease categories.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MW indices may provide prognostic and diagnostic information across multiple cardiac diseases; however, individual indices appear to reflect distinct physiological mechanisms and may demonstrate disease\u2010specific prognostic utility. Given the substantial heterogeneity across disease populations, disease\u2010focused interpretation may be more informative than reliance on an overall pooled estimate. These non\u2010invasive echocardiographic indices may offer incremental value beyond LVEF and GLS for cardiovascular risk stratification and monitoring in selected clinical settings, including chronic cardiovascular disease and cancer therapy\u2010related cardiotoxicity. Prospective multicenter studies are required to standardize optimal cut\u2010off values and support future clinical guideline incorporation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/echo.70544","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:58:18Z","timestamp":1785250698000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non\u2010Invasive Myocardial Work Indices (GWI, GCW, GWW, and GWE) as Predictors of Clinical Outcomes Across Cardiac Diseases: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"43","author":[{"given":"Jeevarathinam","family":"Thirumalai","sequence":"first","affiliation":[{"name":"Department of Paediatric and Neonatal Sciences Saveetha College of Physiotherapy Saveetha Institute of Medical and Technical Sciences, Saveetha University  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Sahal","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Neonatal Sciences Saveetha College of Physiotherapy Saveetha Institute of Medical and Technical Sciences, Saveetha University  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Neonatal Sciences Saveetha College of Physiotherapy Saveetha Institute of Medical and Technical Sciences, Saveetha University  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Global Status Report on Noncommunicable Diseases","author":"World Health Organization","year":"2014"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz859"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwad388"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.12.012"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2007.12.007"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs016"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10194521"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.122.014419"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jey131"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu192"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11030573"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"e_1_2_12_15_1","unstructured":"G. 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