Right Ventricular Myocardial Work Predicts Pulmonary Capillary Wedge Pressure Rise During Exercise in Heart Failure

JACC advances Pub Date : 2025-06-25 DOI:10.1016/j.jacadv.2025.101905

Kuan-Chih Huang MD, PhD , Ting-Tse Lin MD, PhD , Lung-Chun Lin MD, PhD , Lian-Yu Lin MD, PhD , Cho-kai Wu MD, PhD

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Abstract

Background

Symptoms of heart failure with preserved ejection fraction (HFpEF) are closely related to exercise-induced elevation in pulmonary capillary wedge pressure (PCWP). However, the diagnostic role of right ventricular (RV) myocardial work in HFpEF remains unclear.

Objectives

The purpose of this study was to evaluate the diagnostic utility of RV myocardial work in HFpEF and their correlation with PCWP during exercise.

Methods

Patients with unexplained dyspnea underwent invasive cardiopulmonary exercise tests to identify HFpEF. Echocardiography assessed left and right ventricular parameters. RV myocardial work was calculated using strain rate and pressure curves, matched with electrocardiography data. RV global constructive work, RV global work index, RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were analyzed.

Results

Forty-one patients with adequate data were enrolled, with 21 diagnosed with HFpEF. No significant differences in various echocardiographic parameters were found between HFpEF and non-HFpEF groups, except higher postexercise PCWP and mean pulmonary artery pressure in HFpEF patients. HFpEF patients had higher RVGWW and lower RVGWE. RVGWW and RVGWE demonstrated superior diagnostic performance for HFpEF compared to other echocardiographic parameters, with areas under the receiver operating characteristic curve of 0.85 (95% CI: 0.73-0.97) and 0.83 (95% CI: 0.70-0.96), respectively. RV global constructive work (r = 0.504; P = 0.001) and RVGWW (r = 0.621; P < 0.001) correlated with postexercise ΔPCWP and exercise PCWP, with RVGWW independently associated with both after adjustment for confounding factors.

Conclusions

RVGWW is a novel predictive parameter that provides a better explanation of RV performance regarding postexercise ΔPCWP than other standard echocardiographic parameters in HFpEF.

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心衰患者运动时右心室心肌功预测肺毛细血管楔压升高

背景：心力衰竭伴保留射血分数（HFpEF）的症状与运动引起的肺毛细血管楔压（PCWP）升高密切相关。然而，右心室（RV）心肌功在HFpEF中的诊断作用尚不清楚。目的评价运动时右心室心肌功对HFpEF的诊断价值及其与PCWP的相关性。方法对不明原因呼吸困难患者进行有创心肺运动试验，以确定HFpEF。超声心动图评估左、右心室参数。用应变率和压力曲线计算右心室心肌功，并与心电图数据相匹配。分析了RV全球建设性工作、RV全球工作指数、RV全球浪费工作（RVGWW）和RV全球工作效率（RVGWE）。结果纳入41例资料充足的患者，其中21例诊断为HFpEF。除HFpEF组运动后PCWP和平均肺动脉压较高外，HFpEF组与非HFpEF组的各项超声心动图参数均无显著差异。HFpEF患者RVGWW较高，RVGWE较低。与其他超声心动图参数相比，RVGWW和RVGWE对HFpEF的诊断效果更好，受者工作特征曲线下面积分别为0.85 （95% CI: 0.73-0.97）和0.83 （95% CI: 0.70-0.96）。RV整体建设工作(r = 0.504；P = 0.001)和RVGWW (r = 0.621；P & lt;0.001)与运动后ΔPCWP和运动PCWP相关，RVGWW在调整混杂因素后与两者独立相关。结论srvgww是一种新的预测参数，与其他标准超声心动图参数相比，它能更好地解释运动后RV的表现ΔPCWP。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC advances Cardiology and Cardiovascular Medicine

CiteScore

1.90

自引率

0.00%

发文量