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. 2021 Apr 30;21(1):219.
doi: 10.1186/s12872-021-02037-y.

Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension

Raluca Jumatate  1 , Annika Ingvarsson  2 , Gustav Jan Smith  2 , Anders Roijer  2 , Ellen Ostenfeld  3 , Johan Waktare  4 , Göran Rådegran  2 , Carl Meurling  2 , Anna Werther Evaldsson  2
Affiliations

Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension

Raluca Jumatate et al. BMC Cardiovasc Disord. .

Abstract

Background: In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function. The aim of the present study was to comprehensively evaluate non-invasive measures to calculate RVSWI derived by echocardiography (RVSWIECHO) using RHC (RVSWIRHC) as a reference in adult PAH patients.

Methods: Retrospectively, 54 consecutive treatment naïve patients with PAH (65 ± 13 years, 36 women) were analyzed. Echocardiography and RHC were performed within a median of 1 day [IQR 0-1 days]. RVSWIRHC was calculated as: (mean pulmonary arterial pressure (mPAP)-mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHO were evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2 = (TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmeanPG) x SVIECHO and RVSWIECHO-4 = (TRmeanPG-mRAPECHO) x SVIECHO. Estimation of mRAPECHO was derived from inferior vena cava diameter.

Results: RVSWIRHC was 1132 ± 352 mmHg*mL*m-2. In comparison with RVSWIRHC in absolute values, RVSWIECHO-1 and RVSWIECHO-2 was significantly higher (p < 0.001), whereas RVSWIECHO-4 was lower (p < 0.001). No difference was shown for RVSWIECHO-3 (p = 0.304). The strongest correlation, with RVSWIRHC, was demonstrated for RVSWIECHO-2 (r = 0.78, p < 0.001) and RVSWIECHO-1 ( r = 0.75, p < 0.001). RVSWIECHO-3 and RVSWIECHO-4 had moderate correlation (r = 0.66 and r = 0.69, p < 0.001 for all). A good agreement (ICC) was demonstrated for RVSWIECHO-3 (ICC = 0.80, 95% CI 0.64-0.88, p < 0.001), a moderate for RVSWIECHO-4 (ICC = 0.73, 95% CI 0.27-0.87, p < 0.001) and RVSWIECHO-2 (ICC = 0.55, 95% CI - 0.21-0.83, p < 0.001). A poor ICC was demonstrated for RVSWIECHO-1 (ICC = 0.45, 95% CI - 0.18-0.77, p < 0.001). Agreement of absolute values for RVSWIECHO-1 was - 772 ± 385 (- 50 ± 20%) mmHg*mL*m-2, RVSWIECHO-2 - 600 ± 339 (-41 ± 20%) mmHg*mL*m-2, RVSWIECHO-3 42 ± 286 (5 ± 25%) mmHg*mL*m-2 and for RVSWIECHO-4 214 ± 273 (23 ± 27%) mmHg*mL*m-2.

Conclusion: The correlation with RVSWIRHC was moderate to strong for all echocardiographic measures, whereas only RVSWIECHO-3 displayed high concordance of absolute values. The results, however, suggest that RVSWIECHO-1 or RVSWIECHO-3 could be the preferable echocardiographic methods. Prospective studies are warranted to evaluate the clinical utility of such measures in relation to treatment response, risk stratification and prognosis in patients with PAH.

Keywords: Echocardiography; Right heart catheterization; Right ventricular stroke work index.

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Conflict of interest statement

No conflicts of interest.

Figures

Fig. 1
Fig. 1
Echocardiographic illustration of measurement of maximum (yellow dot) and mean (yellow delineation) pressure gradients from a tricuspid regurgitation
Fig. 2
Fig. 2
Scatterplots with regression lines in red, delineates the correlation between right ventricular stroke work index (RVSWI) derived from echocardiography RVSWIECHO1-4 and right heart catheterization (RHC). The blue line represents the reference line. Pearson’s correlation coefficients (r-values) and intra class correlation (ICC) are depicted in the figure. E2 means equal to 100
Fig. 3
Fig. 3
a Bland–Altman plots illustrating the agreement of right ventricular stroke work index (RVSWI) by right heart catheterization and the four different echocardiographic methods for calculation of RVSWI (RVSWIECHO1-4). The red lines represent the absolute bias and the green lines represents the level of agreement (LOA). b Bland–Altman plots based on the percentage differences in RVSWI between right heart catheterization and echocardiography. The red lines represent the relative bias and the green lines represents the level of agreement (LOA)
See this image and copyright information in PMC

References

    1. Fine NM, Chen L, Bastiansen PM, Frantz RP, Pellikka PA, Oh JK, et al. Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension. Circ Cardiovasc Imaging. 2013;6(5):711–721. doi: 10.1161/CIRCIMAGING.113.000640. - DOI - PubMed
    1. Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D34–41. doi: 10.1016/j.jacc.2013.10.029. - DOI - PubMed
    1. Haddad F, Couture P, Tousignant C, Denault AY. The right ventricle in cardiac surgery, a perioperative perspective: I. Anatomy, physiology, and assessment. Anesthesia Analgesia. 2009;108(2):407–21. doi: 10.1213/ane.0b013e31818f8623. - DOI - PubMed
    1. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2010;23(7):685–713; quiz 86–8. - PubMed
    1. Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984;70(4):657–662. doi: 10.1161/01.CIR.70.4.657. - DOI - PubMed

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