Right ventricular global wasted work correlated with pulmonary vascular resistance (R=0.51, p<0.001) and values >175 mmHg% identified patients at high risk for mortality.
Cohort (n=58)
Does echocardiographic right-ventricular global wasted work (RVGWW) predict invasive hemodynamics and high-risk mortality profile in patients with pulmonary arterial hypertension?
Non-invasive echocardiographic assessment of right-ventricular global wasted work correlates with invasive hemodynamics and can identify high-risk profiles in patients with pulmonary arterial hypertension.
Effect estimate: R=0.51 for PVR
p-value: p=<0.001
Abstract Background/Introduction Novel echocardiographic indices of right ventricular myocardial work (RVMW), derived from non-invasive pressure-strain loops, are gaining ground for the evaluation of pulmonary arterial hypertension (PAH). However, their role in predicting hemodynamics and risk profile remains unclear. Purpose This study aimed to assess whether RVMW indices can identify patients at high risk for mortality and those with a worse hemodynamic profile as determined by right heart catheterization (RHC). Methods Patients with PAH, confirmed by RHC, with available echocardiographic images for RVMW estimation were analysed. Patients’ risk profile was determined according to guidelines. RV global work index (RVGWI), global constructive work (RVGCW), global wasted work (RVGWW), and global work efficiency (RVGWE) were measured and correlations with four RHC parameters (mean pulmonary artery pressure mPAP, pulmonary vascular resistance PVR, stroke volume index SVI, pulmonary arterial compliance PAC) were explored. Spline curve analyses were utilized to identify RVMW indices’ cut-off values, associated with ‘high risk’ patients and a worse hemodynamic profile. Results RVMW analysis was completed in 58 PAH patients (58±14 years old, 72% female). RVGWW was significantly increased (p 0.001), while RVGWE was significantly decreased in the ‘high risk’ group (p=0.033). RVGWW correlated with mPAP (R=0.46; p 0.001), PVR (R=0.51; p 0.001), SVI (R=-0.3; p=0.024) and PAC (R=-0.31; p=0.02). Specific cut-off values of RVGWW emerged as predictors of worse hemodynamics based on spline curves; 60 mmHg% indicated low-probability of PVR 5 WU (Figure 1A), 83-84 mmHg% indicated high-probability of PAC 2.3 ml/mmHg and mPAP 40 mmHg (Figure 1B, C), 120 mmHg% indicated SVI 31 ml/m2 in RHC (Figure 1D). Furthermore, RVGWW values 175 mmHg% were associated with patients at high-risk for mortality (Figure 2). Conclusions RVGWW correlated well with invasive hemodynamic parameters and was found to predict a worse hemodynamic and high-risk profile in a prospective cohort of PAH patients.
Kosmidis et al. (Thu,) conducted a cohort in Pulmonary arterial hypertension (n=58). Right ventricular global wasted work (RVGWW) was evaluated on Correlation with invasive hemodynamic parameters (mPAP, PVR, SVI, PAC) (R=0.51 for PVR, p=<0.001). Right ventricular global wasted work correlated with pulmonary vascular resistance (R=0.51, p<0.001) and values >175 mmHg% identified patients at high risk for mortality.