Right ventricular pressure-strain relationship-derived myocardial work reflects contractility: Validation with invasive pressure-volume analysis

Lakatos, Bálint K. and Rako, Zvonimir and Szijártó, Ádám and da Rocha, Bruno R. Brito and Richter, Manuel J. and Fábián, Alexandra and Gall, Henning and Ghofrani, Hossein A. and Kremer, Nils and Seeger, Werner and Zedler, Daniel and Yildiz, Selin and Yogeswaran, Athiththan and Merkely, Béla and Tello, Khodr and Kovács, Attila (2024) Right ventricular pressure-strain relationship-derived myocardial work reflects contractility: Validation with invasive pressure-volume analysis. The Journal of Heart and Lung Transplantation, 43 (7). pp. 1183-1187. ISSN 10532498

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Abstract

Three-dimensional (3D) echocardiography-derived right ventricular (RV) ejection fraction (EF) and global longitudinal strain (GLS) are valuable RV functional markers; nevertheless, they are substantially load-dependent. Global myocardial work index (GMWI) is a novel parameter calculated by the area of the RV pressure-strain loop. By adjusting myocardial deformation to instantaneous pressure, it may reflect contractility. To test this hypothesis, we enrolled 60 patients who underwent RV pressure-conductance catheterization to determine load-independent markers of RV contractility and ventriculo-arterial coupling. Detailed 3D echocardiography was also performed, and we calculated RV EF, RV GLS, and using the RV pressure trace curve, RV GWMI. While neither RV EF nor GLS correlated with Ees, GMWI strongly correlated with Ees. In contrast, RV EF and GLS showed a relationship with Ees/Ea. By dividing the population based on their Reveal Lite 2 risk classification, different characteristics were seen among the subgroups. RV GMWI may emerge as a useful clinical tool for risk stratification and follow-up in patients with RV dysfunction.

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