Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia.
Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece.
Am J Cardiol. 2022 Aug 15;177:151-161. doi: 10.1016/j.amjcard.2022.04.058. Epub 2022 Jun 9.
Noninvasive evaluation of indexes of right ventricular (RV) myocardial work (RVMW) derived from RV pressure-strain loops may provide novel insights into RV function in precapillary pulmonary hypertension. This study was designed to evaluate the association between the indexes of RVMW and invasive parameters of right heart catheterization and all-cause mortality. Noninvasive analysis of RVMW was completed in 51 patients (mean age 58.1 ± 12.7 years, 31% men) with group I or group IV pulmonary hypertension. RV global work index (RVGWI), RV global constructive work (RVGCW), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were compared with parameters derived invasively during right heart catheterization. Patients were followed-up for the occurrence of all-cause death. The median RVGWI, RVGCW, RVGWW, and RVGWE were 620 mm Hg%, 830 mm Hg%, 105 mm Hg% and 87%, respectively. Compared with conventional echocardiographic parameters of RV systolic function, RVGCW and RVGWI correlated more closely with invasively derived RV stroke work index (R = 0.63, p <0.001 and R = 0.60, p <0.001, respectively). Invasively derived pulmonary vascular resistance correlated with RVGWW (R = 0.63, p <0.001), RVGWE (R = 0.48, p <0.001), and RV global longitudinal strain (R = 0.58, p <0.001). RVGCW (hazard ratio 1.42 per 100 mm Hg% <900 mm Hg%, 95% confidence interval 1.12 to 1.81, p = 0.004) and RVGWI (hazard ratio 1.46 per 100 mm Hg% <650 mm Hg%, 95% confidence interval 1.09 to 1.94, p = 0.010) were significantly associated with all-cause mortality, whereas RV global longitudinal strain, RVGWE, and RVGWW were not. In conclusion, indexes of RVMW were more closely correlated with invasively derived RV stroke work index and peripheral vascular resistance than conventional echocardiographic parameters of RV systolic function. Decreased values of RVGCW and RVGWI were associated with all-cause mortality, whereas conventional echocardiographic parameters of RV function were not.
右心室（RV）心肌做功（RVMW）指数的无创评估可能为肺动脉高压患者的 RV 功能提供新的见解。本研究旨在评估 RV 压力-应变环衍生的 RVMW 指数与有创右心导管检查的右心参数和全因死亡率之间的关系。在 51 例 I 组或 IV 组肺动脉高压患者中完成了 RVMW 的无创分析（平均年龄 58.1 ± 12.7 岁，31%为男性）。RV 整体做功指数（RVGWI）、RV 整体做功（RVGCW）、RV 整体无效功（RVGWW）和 RV 整体工作效率（RVGWE）与右心导管检查期间获得的有创参数进行了比较。对患者进行了全因死亡的随访。RVGWI、RVGCW、RVGWW 和 RVGWE 的中位数分别为 620mmHg%、830mmHg%、105mmHg%和 87%。与 RV 收缩功能的常规超声心动图参数相比，RVGCW 和 RVGWI 与有创 RV 搏出功指数（R=0.63，p<0.001 和 R=0.60，p<0.001）的相关性更强。有创肺动脉血管阻力与 RVGWW（R=0.63，p<0.001）、RVGWE（R=0.48，p<0.001）和 RV 整体纵向应变（R=0.58，p<0.001）相关。RVGCW（每增加 100mmHg%<900mmHg%，风险比 1.42，95%置信区间 1.12 至 1.81，p=0.004）和 RVGWI（每增加 100mmHg%<650mmHg%，风险比 1.46，95%置信区间 1.09 至 1.94，p=0.010）与全因死亡率显著相关，而 RV 整体纵向应变、RVGWE 和 RVGWW 则不然。结论：与 RV 收缩功能的常规超声心动图参数相比，RVMW 指数与有创 RV 搏出功指数和外周血管阻力的相关性更强。RVGCW 和 RVGWI 值降低与全因死亡率相关，而 RV 功能的常规超声心动图参数则不相关。
