Right ventricular global work efficiency: A reliable non-invasive estimate of right ventricular contractility

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

ESC Heart Failure Pub Date : 2025-07-03 DOI:10.1002/ehf2.15354

Paolo Manca, Vincenzo Nuzzi, Alessandro Lucchino, Gerardo Rugiano, Massimiliano Mulè, Alessandra Carvelli, Stefano Cannata, Sergio Sciacca, Francesca Parisi, Sabato Sorrentino, Francesco Fulvio Faletra, Paolo C. Colombo, Manlio Gianni Cipriani

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Abstract

Background

Right ventricular (RV) myocardial work (RVMW) recently emerged as a non-invasive alternative for the assessment of RV contractility. However, none of the prior studies assessed its variations under different haemodynamic conditions. We aimed to evaluate the variations of the components of RVMW in heart failure (HF) patients with pulmonary hypertension (PH) undergoing a reversibility test.

Methods

Consecutive HF patients with reduced ejection fraction who underwent right heart catheterization and echocardiography at our institution were prospectively enrolled. Patients with PH and augmented pulmonary vascular resistance who achieved normalization of pulmonary pressures after the reversibility test using vasodilators underwent a second echocardiographic assessment under the same haemodynamic conditions. Four components of RVMW were analysed: (1) RV global work index (mmHg%); (2) RV global constructive work (mmHg%); (3) RV global wasted work (RVGWW) (mmHg%); (4) RV global work efficiency (RVGWE) (%).

Results

One hundred two patients were enrolled (53 with PH and 49 without). Global RVMW was higher in patients with PH, due to a significantly higher RVGWW [81 (55–119) mmHg% vs. 49 (28–72) mmHg%; P = 0.013], while RVGWE was similar between the two groups (80 ± 10% vs. 82 ± 12%; P = 0.332). In patients with PH, 27/52 (51.9%) had combined PH, while 25/52 (48.1%) had isolated post-capillary PH. A reversibility test was performed in 26/27 (96.2%) patients with combined PH and pulmonary pressure normalization was observed in 16/26 (61.5%) subjects. In patients with PH normalization, RVGWE remained almost unchanged (from 82.8 ± 6.9% to 85.3 ± 6.6%; P = 0.596), while RVGWW significantly decreased [from 60 (49–90) mmHg% to 41 (31–53) mmHg%; P = 0.027]. Among all the echocardiographic and haemodynamic parameters adopted for assessing RV function, RVGWE was the least variable during the reversibility test (mean variation 3 ± 10%).

Conclusions

RVGWE is comparable between HF patients with and without PH and remains stable across different haemodynamic conditions. This consistency suggests that it can be a reliable parameter for assessing RV contractility. Larger studies are needed to confirm this hypothesis and to test its prognostic significance.

Abstract Image

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右心室整体工作效率：一个可靠的无创估计右心室收缩。

背景：右心室（RV）心肌功（RVMW）最近成为评估右心室收缩力的一种无创替代方法。然而，之前的研究都没有评估其在不同血流动力学条件下的变化。我们旨在通过可逆性试验评估心力衰竭（HF）合并肺动脉高压（PH）患者RVMW成分的变化。方法：前瞻性纳入在我院接受右心导管和超声心动图检查的连续射血分数降低的心衰患者。在使用血管扩张剂进行可逆性试验后达到肺压力正常化的PH和肺血管阻力增强的患者在相同的血流动力学条件下进行第二次超声心动图评估。分析RVMW的四个组成部分：(1)RVMW整体工作指数（mmHg%）；(2) RV全球建设工作（mmHg%）；(3) RV全球浪费功（RVGWW）（mmHg%）；(4) RV全局工作效率（RVGWE）（%）。结果：共纳入102例患者（53例伴有PH， 49例无PH）。PH患者的RVMW更高，因为RVGWW明显更高[81 (55-119)mmHg% vs 49 (28-72) mmHg%；P = 0.013]，两组RVGWE相似(80±10% vs 82±12%；p = 0.332)。在PH患者中，27/52例（51.9%）合并PH， 25/52例（48.1%）分离毛细血管后PH。26/27例（96.2%）患者进行可逆性试验，16/26例（61.5%）患者合并PH和肺动脉压正常化。在PH正常化的患者中，RVGWE几乎保持不变(从82.8±6.9%降至85.3±6.6%；P = 0.596)， RVGWW从60 (49-90)mmHg%降至41 (31-53)mmHg%；p = 0.027]。在评价右心室功能的超声心动图和血流动力学参数中，RVGWE在可逆性试验中变化最小（平均变异3±10%）。结论：RVGWE在合并和不合并PH的HF患者之间具有可比性，并且在不同的血流动力学条件下保持稳定。这种一致性表明它可以作为评估右心室收缩力的可靠参数。需要更大规模的研究来证实这一假设并检验其预后意义。

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

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.