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Updated: Apr 30, 2026
Hemodynamic Characterization of Rodent Models of Pulmonary Arterial Hypertension
Published on: April 11, 2016
RV stroke work in children with pulmonary arterial hypertension: estimation based on invasive haemodynamic assessment
Michael V Di Maria1, Adel K Younoszai1, Luc Mertens2
1The Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.
Insights
Right ventricular stroke work (RVSW) predicts outcomes in pediatric pulmonary arterial hypertension (PAH). Higher RVSW is linked to worse WHO functional class, need for septostomy, and mortality in children with PAH.
Area of Science:
- Pediatric Cardiology
- Pulmonary Hypertension Research
- Cardiac Physiology
Background:
- Right ventricular (RV) performance is critical for outcomes in pediatric pulmonary arterial hypertension (PAH).
- Right ventricular stroke work (RVSW) integrates RV contractility, afterload, and ventricular-vascular coupling.
- RVSW has not been previously evaluated in pediatric PAH patients.
Purpose of the Study:
- To test the hypothesis that RVSW predicts clinical outcomes in children with PAH.
- To assess the association between RVSW and hemodynamic parameters and RV function.
- To determine if RVSW correlates with disease severity and adverse events.
Main Methods:
- Retrospective analysis of pediatric PAH patients from a specialized database.
- Hemodynamic data collected via catheterization and echocardiography within 3 months.
- Calculation of RVSW indexed to body surface area; statistical analysis using Kruskal-Wallis, Wilcoxon rank sum, and Spearman correlation.
Main Results:
- Fifty pediatric PAH patients were included, with a median age of 9.5 years.
- RVSW showed significant associations with pulmonary vascular resistance (PVRi), tricuspid annular systolic plane excursion, and RV fractional area change.
- Higher RVSW was significantly associated with worse World Health Organization (WHO) functional class, need for atrial septostomy, and mortality.
Conclusions:
- RVSW is a feasible and valuable metric in pediatric PAH.
- RVSW is significantly associated with disease severity and adverse clinical outcomes, including mortality.
- Indices reflecting RV performance and ventricular-vascular coupling, like RVSW, may aid in the prognosis and management of pediatric PAH.
Background:
RV performance is an important determinant of outcomes in children with pulmonary arterial hypertension (PAH). RV stroke work (RVSW), the product of mean pulmonary artery pressure and stroke volume, integrates contractility, afterload and ventricular-vascular coupling. RVSW has not been evaluated in children with PAH. We tested the hypothesis that RVSW would be a predictor of outcomes in children with PAH.
Methods:
Patients in the Children's Hospital Colorado PAH database were evaluated retrospectively, and those with idiopathic PAH and those with minor or repaired congenital heart disease were included. Haemodynamic data were obtained by catheterisation and echocardiography, performed within 3 months. RVSW was calculated: mean pulmonary arterial pressure × stroke volume, and indexed to body surface area. Statistics included Kruskal-Wallis, Wilcoxon rank sum, and Spearman correlation.
Results:
Fifty patients were included. Median age of the cohort was 9.5 (6.0, 15.7) years, with a median indexed pulmonary vascular resistance (PVRi) of 6.5 (3.7, 11.6) WU m(2). RVSW had a significant association with PVRi (r=0.6, p<0.0001), tricuspid annular systolic plane excursion (r=0.55, p=0.0001), and RV fractional area change (r=-0.4, p=0.005). Grouped by WHO class, there was a significant difference in RVSW (p=0.04). Need for atrial septostomy and death were associated with higher RVSW (p=0.04 and p=0.03, respectively).
Conclusions:
RVSW can be estimated in children with PAH, and is significantly associated with abnormal WHO class, the need for septostomy, as well as mortality. Indices accounting for RV performance as well as ventricular-vascular coupling may be useful in the prognosis and, hence, management of children with PAH.
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